pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_a_contract_partd_flag	pbp_a_platino_flag	pbp_a_snp_pct	pbp_a_vbid_indicator	pbp_a_last_data_entry_date	pbpver	pbp_a_ready_for_upload_date_tm	pbp_a_BPT_MA_date_time	pbp_a_BPT_PD_date_time	pbp_a_BPT_MSA_date_time	pbp_a_BPT_ESRD_date_time	pbp_a_upload_date_time	pbp_a_org_name	pbp_a_org_marketing_name	pbp_a_org_website	pbp_a_plan_name	pbp_a_org_type	pbp_a_plan_type	pbp_a_network_flag	pbp_a_ben_cov	pbp_a_hospice_care_yn	pbp_a_service_area	pbp_a_contract_number	pbp_a_plan_identifier	pbp_a_segment_id	pbp_a_contract_period	pbp_a_plan_geog_name	pbp_a_segment_name	pbp_a_eghp_yn	pbp_a_est_memb	pbp_a_continue_yn	pbp_a_continue_costshare_yn	pbp_a_platino_yn	pbp_a_special_need_flag	pbp_a_special_need_plan_type	pbp_a_snp_institutional_type	pbp_a_dsnp_zerodollar	pbp_a_snp_cond	pbp_a_snp_state_cvg_yn	pbp_a_pharmacy_website	pbp_a_formulary_web_addr	pbp_a_phys_web_addr	pbp_a_curmbr_phone	pbp_a_curmbr_phone_ext	pbp_a_curmbr_loc_phone	pbp_a_curmbr_loc_phone_ext	pbp_a_prombr_phone	pbp_a_prombr_phone_ext	pbp_a_prombr_loc_phone	pbp_a_prombr_loc_phone_ext	pbp_a_pd_curmbr_phone	pbp_a_pd_curmbr_phone_ext	pbp_a_pd_curmbr_loc_phone	pbp_a_pd_curmbr_loc_phone_ext	pbp_a_pd_prombr_phone	pbp_a_pd_prombr_phone_ext	pbp_a_pd_prombr_loc_phone	pbp_a_pd_prombr_loc_phone_ext	pbp_a_ttytdd_curmbr_phone	pbp_a_ttytdd_curmbr_phone_ext	pbp_a_ttytdd_cur_loc_phone	pbp_a_ttytdd_cur_loc_phone_ext	pbp_a_ttytdd_prombr_phone	pbp_a_ttytdd_prombr_phone_ext	pbp_a_ttytdd_pro_loc_phone	pbp_a_ttytdd_pro_loc_phone_ext	pbp_a_pd_ttytdd_curmbr_phone	pbp_a_pd_ttytdd_curmbr_phn_ext	pbp_a_pd_ttytdd_cur_loc_phone	pbp_a_pd_ttytdd_cur_loc_phn_ex	pbp_a_pd_ttytdd_prombr_phone	pbp_a_pd_ttytdd_prombr_phn_ext	pbp_a_pd_ttytdd_pro_loc_phone	pbp_a_pd_ttytdd_pro_loc_phn_ex	pbp_a_ffs_bid_b_yn	pbp_a_ffs_bid_b_auth_yn	pbp_a_ffs_bid_b_auth_cats	pbp_a_ffs_bid_b_ref_yn	pbp_a_ffs_bid_b_ref_cats	pbp_a_ffs_bid_c_yn	pbp_a_ffs_bid_c_auth_yn	pbp_a_ffs_bid_c_auth_cats	pbp_a_ffs_bid_c_ref_yn	pbp_a_ffs_bid_c_ref_cats	pbp_a_ffs_bid_d_yn	pbp_a_tier_yn	pbp_a_tier_bendesc_bens	pbp_a_tier_mc_bendesc_cats	pbp_a_tier_nmc_bendesc_cats
E0654	801	0		30	13	E0654_801_0	1	1				06/04/2018	2019.01	06/04/2018 05:59:48 PM Eastern Daylight Time					06/04/2018 06:07:45 PM Eastern Daylight Time	IBT VOLUNTARY EMPLOYEE BENEFITS TRUST	TEAMStar Medicare Part D Prescription Drug Program	www.teamstarpartd.com	IBT Voluntary Employee Benefits Trust (Employer PDP)	13	30					E0654	801	0	2019	National		1					2						www.teamstarpartd.com	www.teamstarpartd.com										(866)524-4173		(866)524-4173		(866)524-4173		(866)524-4173										(711)-		(711)-		(711)-		(711)-																
E3014	801	0		30	13	E3014_801_0	1	1				05/31/2018	2019.01	05/31/2018 03:46:38 PM Eastern Daylight Time					05/31/2018 03:48:22 PM Eastern Daylight Time	PSERS HOP PROGRAM	Pennsylvania Public School Employees Retirement Sy	www.hopbenefits.com	PSERS Health Options Program (Employer PDP)	13	30					E3014	801	0	2019	National		1					2						www.hopbenefits.com	www.hopbenefits.com										(888)239-1301		(888)239-1301		(800)773-7725		(800)773-7725										(800)498-5428		(800)498-5428		(800)498-5428		(800)498-5428																
E3014	802	0		30	13	E3014_802_0	1	1				05/31/2018	2019.01	05/31/2018 03:47:48 PM Eastern Daylight Time					05/31/2018 03:48:22 PM Eastern Daylight Time	PSERS HOP PROGRAM	Pennsylvania Public School Employees Retirement Sy	www.hopbenefits.com	PSERS Health Options Program Value (Employer PDP)	13	30					E3014	802	0	2019	National		1					2						www.hopbenefits.com	www.hopbenefits.com										(888)239-1301		(888)239-1301		(800)773-7725		(800)773-7725										(800)498-5428		(800)498-5428		(800)498-5428		(800)498-5428																
E4744	801	0		30	13	E4744_801_0	2	1				05/17/2018	2019.01	05/17/2018 09:49:48 AM Mountain Daylight Time					05/17/2018 09:49:57 AM Mountain Daylight Time	MODOT/MSHP MEDICAL AND LIFE INSURANCE PLAN	MISSOURI DEPARTMENT OF TRANSPORTATION	http://www.modot.org/newsandinfo/GeneralInfo.htm	Missouri Department of Transportatio/ Highway Patr (Employer PDP)	13	30					E4744	801	0	2019	National		1					2						https://mp.medimpact.com/pharmacyportal/public/Login.jsp	http://www.modot.org/newsandinfo/GeneralInfo/documents/Formulary.htm										(844)513-6006		(844)513-6006		(877)863-9406		(573)751-2551										(711)-		(711)-		(711)-		(711)-																
H0022	001	0	1	48	05	H0022_001_0	7	1				08/23/2018	2019.01	08/23/2018 09:33:55 AM Eastern Daylight Time					08/23/2018 08:46:46 AM Pacific Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Buckeye Health Plan - MyCare Ohio	mmp.buckeyehealthplan.com	Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H0022	001	0	2019	Cleveland, Dayton, Toledo and surrounding counties		2	10156	2			2						mmp.buckeyehealthplan.com/2017/benefits/find-a-doctor-or-pharmacy	mmp.buckeyehealthplan.com/2017/prescription-drug-part-d/formulary	mmp.buckeyehealthplan.com/2017/benefits/find-a-doctor-or-pharmacy	(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0028	004	0	1	01	01	H0028_004_0	5	1				07/18/2018	2019.01	07/18/2018 05:23:21 PM Eastern Daylight Time	06/01/2018 03:02:38 PM Eastern Daylight Time	08/03/2018 09:20:55 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-004 (HMO)	01	01		1			H0028	004	0	2019	Honolulu, Kauai and Maui counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	007	0	1	01	01	H0028_007_0	5	1	2	1		08/01/2018	2019.01	08/01/2018 01:03:18 PM Eastern Daylight Time	08/03/2018 06:33:19 PM Eastern Daylight Time	08/03/2018 09:20:55 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-007 (HMO SNP)	01	01		1			H0028	007	0	2019	Douglas County		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	011	0	1	01	01	H0028_011_0	5	1				07/02/2018	2019.01	07/02/2018 04:44:01 PM Eastern Daylight Time	07/18/2018 03:14:22 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-011 (HMO)	01	01		1			H0028	011	0	2019	Heartland		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	012	0	1	01	01	H0028_012_0	3	1				07/02/2018	2019.01	07/02/2018 01:03:13 PM Eastern Daylight Time	07/18/2018 02:13:43 PM Eastern Daylight Time				07/18/2018 04:21:15 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-012 (HMO)	01	01		1			H0028	012	0	2019	Kansas City Metro area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0028	013	0	1	01	01	H0028_013_0	3	1				07/03/2018	2019.01	07/03/2018 11:07:05 AM Eastern Daylight Time	06/01/2018 02:45:44 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-013 (HMO)	01	01		1			H0028	013	0	2019	Wichita area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	014	0	1	01	01	H0028_014_0	5	1				07/10/2018	2019.01	07/10/2018 04:24:17 PM Eastern Daylight Time	06/01/2018 02:37:02 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-014 (HMO)	01	01		1			H0028	014	0	2019	St. Louis Metro area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	015	0	1	01	01	H0028_015_0	4	1	2	1		07/02/2018	2019.01	07/02/2018 03:49:11 PM Eastern Daylight Time	07/18/2018 02:16:11 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-015 (HMO SNP)	01	01		1			H0028	015	0	2019	Select counties in Missouri		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	016	0	1	01	01	H0028_016_0	4	1				07/18/2018	2019.01	07/18/2018 04:51:17 PM Eastern Daylight Time	06/01/2018 02:40:23 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-016 (HMO)	01	01		1			H0028	016	0	2019	Springfield/Joplin		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	017	0	1	01	01	H0028_017_0	4	1				07/18/2018	2019.01	07/18/2018 04:51:37 PM Eastern Daylight Time	06/01/2018 02:38:39 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-017 (HMO)	01	01		1			H0028	017	0	2019	Kansas City		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	018	0	1	01	01	H0028_018_0	3	1				07/02/2018	2019.01	07/02/2018 03:51:07 PM Eastern Daylight Time	06/01/2018 02:53:47 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Value Plus H0028-018 (HMO)	01	01		1			H0028	018	0	2019	Select counties in Kansas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	019	0	1	01	01	H0028_019_0	5	1				07/02/2018	2019.01	07/02/2018 04:08:44 PM Eastern Daylight Time	07/17/2018 03:01:07 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-019 (HMO)	01	01		1			H0028	019	0	2019	Albuquerque Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H0028	020	0	1	01	01	H0028_020_0	5	1				07/16/2018	2019.01	07/16/2018 12:54:52 PM Eastern Daylight Time	07/17/2018 03:01:54 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-020 (HMO)	01	01		1			H0028	020	0	2019	Maricopa and Pinal counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	021	0	1	01	01	H0028_021_0	4	1				07/02/2018	2019.01	07/02/2018 04:11:35 PM Eastern Daylight Time	06/01/2018 03:24:57 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-021 (HMO)	01	01		1			H0028	021	0	2019	Pima County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	022	0	1	01	01	H0028_022_0	4	1				07/02/2018	2019.01	07/02/2018 04:12:49 PM Eastern Daylight Time	06/01/2018 03:25:31 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-022 (HMO)	01	01		1			H0028	022	0	2019	La Paz and Mohave counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	023	0	1	01	01	H0028_023_0	4	1				07/02/2018	2019.01	07/02/2018 04:14:16 PM Eastern Daylight Time	06/01/2018 03:26:12 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-023 (HMO)	01	01		1			H0028	023	0	2019	Yavapai County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	024	0	1	01	01	H0028_024_0	5	1				07/02/2018	2019.01	07/02/2018 04:17:12 PM Eastern Daylight Time	07/17/2018 03:02:39 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-024 (HMO)	01	01		1			H0028	024	0	2019	La Paz and Mohave counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	025	1	1	01	01	H0028_025_1	4	1				07/02/2018	2019.01	07/02/2018 04:18:35 PM Eastern Daylight Time	06/01/2018 03:31:45 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	01	01		1			H0028	025	1	2019	Colorado	Denver Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8b3;	
H0028	025	2	1	01	01	H0028_025_2	4	1				07/02/2018	2019.01	07/02/2018 04:19:55 PM Eastern Daylight Time	06/01/2018 03:32:29 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	01	01		1			H0028	025	2	2019	Colorado	North and South Colorado Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H0028	026	1	1	01	01	H0028_026_1	5	1				07/02/2018	2019.01	07/02/2018 04:21:19 PM Eastern Daylight Time	07/17/2018 03:03:16 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-026 (HMO)	01	01		1			H0028	026	1	2019	Denver Metro Area	Denver Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H0028	026	2	1	01	01	H0028_026_2	5	1				07/18/2018	2019.01	07/18/2018 03:46:49 PM Eastern Daylight Time	06/01/2018 03:28:13 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-026 (HMO)	01	01		1			H0028	026	2	2019	Denver Metro Area	North and South Colorado Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8b3;	
H0028	027	0	1	01	01	H0028_027_0	4	1				07/02/2018	2019.01	07/02/2018 04:23:55 PM Eastern Daylight Time	06/01/2018 03:28:55 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-027 (HMO)	01	01		1			H0028	027	0	2019	Maricopa County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;7a;7g;8a1;8b3;	
H0028	028	0	1	01	01	H0028_028_0	5	1				07/02/2018	2019.01	07/02/2018 04:25:10 PM Eastern Daylight Time	08/03/2018 01:40:39 PM Eastern Daylight Time	08/03/2018 09:20:56 AM Eastern Daylight Time			08/06/2018 12:34:14 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-028 (HMO)	01	01		1			H0028	028	0	2019	Maricopa County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	029	0	1	01	01	H0028_029_0	5	1				07/10/2018	2019.01	07/10/2018 03:51:32 PM Eastern Daylight Time	06/01/2018 03:13:40 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-029 (HMO)	01	01		1			H0028	029	0	2019	Corpus Christi Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	030	0	1	01	01	H0028_030_0	4	1				07/10/2018	2019.01	07/10/2018 03:56:22 PM Eastern Daylight Time	06/01/2018 03:14:20 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-030 (HMO)	01	01		1			H0028	030	0	2019	San Antonio Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	031	0	1	01	01	H0028_031_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 09:07:12 AM Eastern Daylight Time	08/03/2018 03:05:23 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-031 (HMO SNP)	01	01		1			H0028	031	0	2019	Select Counties in Texas		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	032	0	1	01	01	H0028_032_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 09:08:36 AM Eastern Daylight Time	08/03/2018 03:15:21 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-032 (HMO SNP)	01	01		1			H0028	032	0	2019	Select Counties in Texas		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	033	0	1	01	01	H0028_033_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 09:09:16 AM Eastern Daylight Time	08/03/2018 03:20:07 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-033 (HMO SNP)	01	01		1			H0028	033	0	2019	Fort Bend, Harris and Montgomery counties		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	034	0	1	01	01	H0028_034_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 09:09:55 AM Eastern Daylight Time	08/03/2018 03:22:56 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-034 (HMO SNP)	01	01		1			H0028	034	0	2019	El Paso County		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	035	0	1	01	01	H0028_035_0	5	1				07/16/2018	2019.01	07/16/2018 01:12:24 PM Eastern Daylight Time	08/03/2018 03:07:51 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-035 (HMO)	01	01		1			H0028	035	0	2019	El Paso County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	036	0	1	01	01	H0028_036_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 01:27:32 PM Eastern Daylight Time	08/03/2018 03:10:07 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-036 (HMO SNP)	01	01		1			H0028	036	0	2019	Corpus Christi/San Antonio area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	037	0	1	01	01	H0028_037_0	5	1				07/10/2018	2019.01	07/10/2018 04:17:18 PM Eastern Daylight Time	06/01/2018 03:17:07 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-037 (HMO)	01	01		1			H0028	037	0	2019	Hays, Travis and Williamson counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	038	0	1	01	01	H0028_038_0	5	1				07/10/2018	2019.01	07/10/2018 04:20:13 PM Eastern Daylight Time	07/18/2018 02:08:12 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-038 (HMO)	01	01		1			H0028	038	0	2019	Houston Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	039	0	1	01	01	H0028_039_0	4	1		1		07/11/2018	2019.01	07/11/2018 07:58:45 AM Eastern Daylight Time	06/01/2018 03:18:31 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H0028	039	0	2019	Corpus Christi Metro Area		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	040	0	1	01	01	H0028_040_0	4	1		1		07/11/2018	2019.01	07/11/2018 08:00:22 AM Eastern Daylight Time	06/01/2018 03:19:12 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H0028	040	0	2019	San Antonio Metro Area		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	041	0	1	01	01	H0028_041_0	5	1				07/11/2018	2019.01	07/11/2018 08:05:14 AM Eastern Daylight Time	07/18/2018 02:13:03 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-041 (HMO)	01	01		1			H0028	041	0	2019	Select Counties in Texas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	042	0	1	01	01	H0028_042_0	3	1				07/11/2018	2019.01	07/11/2018 08:08:48 AM Eastern Daylight Time	06/01/2018 03:20:35 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-042 (HMO)	01	01		1			H0028	042	0	2019	Houston Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	043	1	1	01	01	H0028_043_1	4	1				07/11/2018	2019.01	07/11/2018 08:11:07 AM Eastern Daylight Time	07/18/2018 02:15:40 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	01	01		1			H0028	043	1	2019	Dallas area	Dallas area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	043	2	1	01	01	H0028_043_2	4	1				07/11/2018	2019.01	07/11/2018 08:12:37 AM Eastern Daylight Time	07/18/2018 02:18:15 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	01	01		1			H0028	043	2	2019	Dallas area	Dallas area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	801	0	1	01	01	H0028_801_0	2	1				05/31/2018	2019.01	05/31/2018 12:17:38 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	801	0	2019	Select Counties in Multi States		1	47805	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0028	802	0	1	01	01	H0028_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:18:44 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	802	0	2019	Select Counties in Multi States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0029	801	0	1	01	01	H0029_801_0	1	1				05/29/2018	2019.01	05/29/2018 05:26:51 PM Pacific Daylight Time					06/03/2018 08:55:05 PM Pacific Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	801	0	2019	Pierce and Spokane Counties		1	100	2			2						allwell.coordinatedcarehealth.com/findadoctor	allwell.coordinatedcarehealth.com/formulary	allwell.coordinatedcarehealth.com/findadoctor	(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0029	802	0	1	01	01	H0029_802_0	1	1				05/29/2018	2019.01	05/29/2018 04:01:36 PM Pacific Daylight Time					06/03/2018 08:55:05 PM Pacific Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	802	0	2019	Pierce and Spokane Counties		1	100	2			2						allwell.coordinatedcarehealth.com/findadoctor	allwell.coordinatedcarehealth.com/formulary	allwell.coordinatedcarehealth.com/findadoctor	(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0029	803	0	1	01	01	H0029_803_0	1	1				05/29/2018	2019.01	05/29/2018 04:01:52 PM Pacific Daylight Time					06/03/2018 08:55:05 PM Pacific Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	803	0	2019	Pierce and Spokane Counties		1	100	2			2						allwell.coordinatedcarehealth.com/findadoctor	allwell.coordinatedcarehealth.com/formulary	allwell.coordinatedcarehealth.com/findadoctor	(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0062	001	0	1	01	01	H0062_001_0	6	1				08/01/2018	2019.01	08/01/2018 11:52:15 AM Eastern Daylight Time	08/03/2018 07:22:17 PM Eastern Daylight Time	08/03/2018 07:51:37 PM Eastern Daylight Time			08/03/2018 08:20:12 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	01	01		1			H0062	001	0	2019	San Antonio Metro		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	002	0	1	01	01	H0062_002_0	6	1				08/01/2018	2019.01	08/01/2018 11:54:29 AM Eastern Daylight Time	08/03/2018 07:22:18 PM Eastern Daylight Time	08/03/2018 07:51:37 PM Eastern Daylight Time			08/03/2018 08:20:12 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	01	01		1			H0062	002	0	2019	Dallas Metro		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	003	0	1	01	01	H0062_003_0	5	1				08/01/2018	2019.01	08/01/2018 11:58:14 AM Eastern Daylight Time	08/03/2018 07:22:18 PM Eastern Daylight Time	08/03/2018 07:51:37 PM Eastern Daylight Time			08/03/2018 08:20:12 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	01	01		1			H0062	003	0	2019	Hidalgo and Cameron Counties		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	004	0	1	01	01	H0062_004_0	6	1				08/06/2018	2019.01	08/06/2018 04:28:12 PM Eastern Daylight Time	08/06/2018 09:06:51 PM Eastern Daylight Time	08/06/2018 09:07:19 PM Eastern Daylight Time			08/06/2018 09:26:09 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	01	01		1			H0062	004	0	2019	El Paso County		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	005	0	1	01	01	H0062_005_0	5	1				08/01/2018	2019.01	08/01/2018 12:19:27 PM Eastern Daylight Time	08/03/2018 07:22:18 PM Eastern Daylight Time	08/03/2018 07:51:38 PM Eastern Daylight Time			08/03/2018 08:20:12 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	01	01		1			H0062	005	0	2019	Nueces County		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	009	0	1	01	01	H0062_009_0	5	1				08/01/2018	2019.01	08/01/2018 01:32:17 PM Eastern Daylight Time	08/03/2018 07:22:19 PM Eastern Daylight Time	08/03/2018 07:51:38 PM Eastern Daylight Time			08/03/2018 08:20:12 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	01	01		1			H0062	009	0	2019	Suburban Houston		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	010	0	1	01	01	H0062_010_0	5	1				08/01/2018	2019.01	08/01/2018 01:33:07 PM Eastern Daylight Time	08/03/2018 07:22:19 PM Eastern Daylight Time	08/03/2018 07:51:38 PM Eastern Daylight Time			08/03/2018 08:20:12 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	01	01		1			H0062	010	0	2019	North Austin		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	801	0	1	01	01	H0062_801_0	3	1				05/29/2018	2019.01	05/29/2018 04:02:15 PM Pacific Daylight Time					06/04/2018 07:21:39 PM Pacific Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	801	0	2019	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0062	802	0	1	01	01	H0062_802_0	3	1				05/29/2018	2019.01	05/29/2018 04:02:23 PM Pacific Daylight Time					06/04/2018 07:21:39 PM Pacific Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	802	0	2019	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0062	803	0	1	01	01	H0062_803_0	3	1				05/29/2018	2019.01	05/29/2018 05:26:57 PM Pacific Daylight Time					06/04/2018 07:21:39 PM Pacific Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	803	0	2019	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0088	001	0	1	04	01	H0088_001_0	4	1				08/07/2018	2019.01	08/07/2018 02:22:39 PM Eastern Daylight Time	08/06/2018 06:28:39 PM Eastern Daylight Time	08/01/2018 01:54:27 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H0088	001	0	2019	Select Counties in NY		2	5710	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	3-1;3-2;7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8a1;8a2;8b1;8b3;9a1;9a2;9b;9c;9d;14e3;14e5;16b;17a;18a;	
H0104	012	0	1	04	01	H0104_012_0	4	1				08/07/2018	2019.01	08/07/2018 01:46:18 PM Central Daylight Time	08/06/2018 09:10:31 AM Central Daylight Time	08/06/2018 09:10:32 AM Central Daylight Time			08/07/2018 02:06:15 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	012	0	2019	Alabama		2	392802	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0104	014	0	1	04	01	H0104_014_0	4	1				08/07/2018	2019.01	08/07/2018 01:46:41 PM Central Daylight Time	08/06/2018 09:10:32 AM Central Daylight Time	08/06/2018 09:10:33 AM Central Daylight Time			08/07/2018 02:06:15 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	014	0	2019	Birmingham/Mobile		2	371190	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0104	015	0	1	04	01	H0104_015_0	3	1				08/07/2018	2019.01	08/07/2018 11:06:22 AM Central Daylight Time	08/06/2018 09:10:33 AM Central Daylight Time	08/06/2018 09:10:34 AM Central Daylight Time			08/07/2018 02:17:57 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	015	0	2019	Alabama		2	80892	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0104	801	0	1	04	01	H0104_801_0	2	1				05/31/2018	2019.01	05/31/2018 01:33:10 PM Central Daylight Time					06/02/2018 11:18:30 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 801 (PPO)	01	04		1			H0104	801	0	2019	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0104	802	0	1	04	01	H0104_802_0	1	1				05/29/2018	2019.01	05/29/2018 01:00:32 PM Central Daylight Time					06/02/2018 11:28:35 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 802 (PPO)	01	04		1			H0104	802	0	2019	State of Alabama		1	260000	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	804	0	1	04	01	H0104_804_0	2	1				05/31/2018	2019.01	05/31/2018 01:33:23 PM Central Daylight Time					06/02/2018 11:18:30 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 804 (PPO)	01	04		1			H0104	804	0	2019	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	805	0	1	04	01	H0104_805_0	2	1				05/31/2018	2019.01	05/31/2018 01:33:36 PM Central Daylight Time					06/02/2018 11:18:30 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 805 (PPO)	01	04		1			H0104	805	0	2019	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	806	0	1	04	01	H0104_806_0	2	1				05/31/2018	2019.01	05/31/2018 01:33:56 PM Central Daylight Time					06/02/2018 11:18:30 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 806 (PPO)	01	04		1			H0104	806	0	2019	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	807	0	1	04	01	H0104_807_0	1	1				05/23/2018	2019.01	05/23/2018 10:53:03 AM Central Daylight Time					06/02/2018 11:28:35 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 807 (PPO)	01	04		1			H0104	807	0	2019	State of Alabama		1	264000	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0105	001	0	1	20	08	H0105_001_0	1	1				05/23/2018	2019.01	05/23/2018 09:42:04 AM Eastern Daylight Time		05/23/2018 09:39:26 AM Eastern Daylight Time			05/23/2018 09:43:45 AM Eastern Daylight Time	THE METHODIST OAKS	The Methodist Oaks d.b.a. The Oaks PACE	http://www.theoakspace.com	The Methodist Oaks d.b.a. The Oaks PACE (PACE)	08	20		1			H0105	001	0	2019	Rural South Carolina		2		2			2						http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(855)268-5300		(803)268-5300		(803)268-5300		(803)268-5300										(855)268-5300		(803)535-1561		(803)268-5300		(803)535-1561																
H0105	002	0	1	20	08	H0105_002_0	1	1				05/23/2018	2019.01	05/23/2018 09:42:17 AM Eastern Daylight Time		05/23/2018 09:39:04 AM Eastern Daylight Time			05/23/2018 09:43:45 AM Eastern Daylight Time	THE METHODIST OAKS	The Methodist Oaks d.b.a. The Oaks PACE	http://www.theoakspace.com	The Methodist Oaks d.b.a. The Oaks PACE (PACE)	08	20		1			H0105	002	0	2019	Rural South Carolina		2		2			2						http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(855)268-5300		(803)268-5300		(803)268-5300		(803)268-5300										(855)268-5300		(803)535-1561		(803)268-5300		(803)535-1561																
H0107	003	0	1	04	01	H0107_003_0	7	1				07/18/2018	2019.01	07/18/2018 01:41:30 PM Mountain Daylight Time	08/06/2018 11:40:57 AM Mountain Daylight Time	08/01/2018 10:44:20 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H0107	003	0	2019	Montana		2	214270	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/druglist	www.getbluemt.com/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	004	0	1	04	01	H0107_004_0	6	1				07/09/2018	2019.01	07/09/2018 09:25:44 AM Mountain Daylight Time	08/06/2018 11:41:44 AM Mountain Daylight Time	08/01/2018 10:45:23 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Optimum (PPO)	01	04		1			H0107	004	0	2019	Montana		2	60429	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/druglist	www.getbluemt.com/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	801	0	1	04	01	H0107_801_0	2	1				06/18/2018	2019.01	06/18/2018 01:52:40 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Employer Ideal (PPO)	01	04		1			H0107	801	0	2019	Montana		1	14406	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/druglist	www.getbluemt.com/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H0107	802	0	1	04	01	H0107_802_0	2	1				06/18/2018	2019.01	06/18/2018 01:53:15 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Employer Expanded (PPO)	01	04		1			H0107	802	0	2019	Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/druglist	www.getbluemt.com/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H0107	803	0	1	04	01	H0107_803_0	2	1				06/18/2018	2019.01	06/18/2018 01:53:38 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage (PPO)	01	04		1			H0107	803	0	2019	State of Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/druglist	www.getbluemt.com/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H0111	001	0	1	04	01	H0111_001_0	5	1				08/03/2018	2019.01	08/03/2018 12:45:43 PM Eastern Daylight Time	08/06/2018 03:59:31 PM Eastern Daylight Time	08/01/2018 01:54:48 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H0111	001	0	2019	Selected GA Counties		2	36291	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-7730		(866)334-7730		(866)527-0056		(866)527-0056		(866)334-7730		(866)334-7730		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	002	0	1	04	01	H0111_002_0	4	1				08/03/2018	2019.01	08/03/2018 12:46:19 PM Eastern Daylight Time	08/06/2018 04:00:14 PM Eastern Daylight Time	08/01/2018 01:55:09 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	01	04		1			H0111	002	0	2019	Selected GA Counties		2	28172	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(186)633-4773		(186)633-4773		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0112	001	0	1	20	08	H0112_001_0	3	1				05/30/2018	2019.01	05/30/2018 12:19:00 PM Eastern Daylight Time		05/30/2018 04:27:29 PM Eastern Daylight Time			05/30/2018 04:28:46 PM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	001	0	2019	Palm Beach County (partial)		2		2			2						MorseLife.org	N/A										(855)572-7223		(561)687-5745		(855)572-7223		(561)687-5745										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771																
H0112	002	0	1	20	08	H0112_002_0	3	1				05/30/2018	2019.01	05/30/2018 11:50:47 AM Eastern Daylight Time		05/30/2018 04:27:48 PM Eastern Daylight Time			05/30/2018 04:28:46 PM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	002	0	2019	Palm Beach County (partial)		2		2			2						MorseLife.org	N/A										(855)572-7223		(561)687-5745		(855)572-7223		(561)687-5745										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771																
H0137	001	0	1	48	05	H0137_001_0	2	1				06/28/2018	2019.01	06/28/2018 02:19:56 PM Eastern Daylight Time					06/28/2018 02:22:24 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthonecare.org	Commonwealth Care Alliance (Medicare-Medicaid Plan)	05	48		1			H0137	001	0	2019	ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR.		2	232804	2			2						http://www.commonwealthcarealliance.org/members/pharmacy-program	http://www.commonwealthcarealliance.org/getmedia/8f619f5e-50ea-48b6-93b6-61c64af5f723/2018_OneCare_F	www.commonwealthcarealliance.org	(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0148	001	0	1	48	05	H0148_001_0	2	1				07/05/2018	2019.01	07/05/2018 10:47:37 AM Pacific Daylight Time					07/05/2018 10:49:27 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/calmediconnect	Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	001	0	2019	San Diego County		2	2500	2			2						www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0148	002	0	1	48	05	H0148_002_0	2	1				07/05/2018	2019.01	07/05/2018 10:58:43 AM Pacific Daylight Time					07/05/2018 10:59:10 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/calmediconnect	Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	002	0	2019	Los Angeles County		2	5000	2			2						www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0154	008	0	1	01	01	H0154_008_0	2	1				05/30/2018	2019.01	05/30/2018 03:07:56 PM Central Daylight Time	05/30/2018 11:47:20 AM Central Daylight Time				05/31/2018 02:56:59 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Select (HMO)	01	01		1			H0154	008	0	2019	Northwest, Central, and South Alabama		2		2			2						http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0154	011	0	1	01	01	H0154_011_0	5	1				08/07/2018	2019.01	08/07/2018 10:58:05 AM Central Daylight Time	08/07/2018 01:29:27 PM Central Daylight Time	08/07/2018 01:29:27 PM Central Daylight Time			08/07/2018 01:47:16 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Premier (HMO)	01	01		1			H0154	011	0	2019	Northwest, Central and South Alabama		2		2			2						www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	012	0	1	01	01	H0154_012_0	7	1	2	1		08/07/2018	2019.01	08/07/2018 10:58:29 AM Central Daylight Time	08/07/2018 01:29:25 PM Central Daylight Time	08/07/2018 01:29:25 PM Central Daylight Time			08/07/2018 01:47:16 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Extra Value (HMO SNP)	01	01		1			H0154	012	0	2019	Northwest, Central, and South Alabama		2		2			1	3		2		2	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	014	0	1	01	01	H0154_014_0	5	1				08/07/2018	2019.01	08/07/2018 10:59:03 AM Central Daylight Time	08/07/2018 01:29:25 PM Central Daylight Time	08/07/2018 01:29:25 PM Central Daylight Time			08/07/2018 01:47:16 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Me (HMO)	01	01		1			H0154	014	0	2019	Central Alabama		2		2			2						www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	015	1	1	01	01	H0154_015_1	7	1				08/08/2018	2019.01	08/08/2018 12:29:55 PM Central Daylight Time	08/07/2018 01:29:26 PM Central Daylight Time	08/07/2018 01:29:26 PM Central Daylight Time			08/08/2018 01:30:32 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	1	2019	Northwest, Central, and South Alabama	Northwest, Central and South Alabama	2		2			2						www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	015	2	1	01	01	H0154_015_2	7	1				08/07/2018	2019.01	08/07/2018 11:02:45 AM Central Daylight Time	08/07/2018 01:29:26 PM Central Daylight Time	08/07/2018 01:29:26 PM Central Daylight Time			08/07/2018 01:47:16 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	2	2019	Northwest, Central, and South Alabama	Ft Payne, Troy, Jasper, Russellville Area	2		2			2						www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	016	0	1	01	01	H0154_016_0	5	1				07/31/2018	2019.01	07/31/2018 05:25:59 PM Central Daylight Time	08/07/2018 01:29:27 PM Central Daylight Time	08/07/2018 01:29:27 PM Central Daylight Time			08/07/2018 01:47:16 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com	VIVA Medicare Prime (HMO)	01	01		1			H0154	016	0	2019	Northwest, Central and South Alabama		2		2			2						www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	801	0	1	01	01	H0154_801_0	2	1				05/30/2018	2019.01	05/30/2018 03:40:02 PM Central Daylight Time					05/31/2018 02:56:59 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Group Plan with Rx (CY) (HMO)	01	01		1			H0154	801	0	2019	State of Alabama		1	2100	2			2						www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;12;15;16b;	1	7d;	1					2				
H0154	802	0	1	01	01	H0154_802_0	2	1				05/26/2018	2019.01	05/26/2018 09:47:22 AM Central Daylight Time					05/31/2018 02:56:59 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Group Plan (no Rx) (HMO)	01	01		1			H0154	802	0	2019	State of Alabama		1	1080	2			2						http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;12;15;16b;	1	7d;	1					1				
H0154	803	0	1	01	01	H0154_803_0	2	1				05/26/2018	2019.01	05/26/2018 09:48:02 AM Central Daylight Time					05/31/2018 02:56:59 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Plus Group Plan with Rx (not CY) (HMO)	01	01		1			H0154	803	0	2019	State of Alabama		1	2100	2			2						www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/MemberResources/	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;12;15;16b;	1	7d;	1					2				
H0169	001	0	1	01	01	H0169_001_0	3	1	2	1		07/12/2018	2019.01	07/12/2018 09:52:37 AM Central Daylight Time	08/03/2018 09:07:39 AM Central Daylight Time	07/31/2018 05:05:56 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0169	001	0	2019	Select Counties in Iowa		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-6883		(844)368-6883		(888)834-3721		(888)834-3721		(844)368-6883		(844)368-6883		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0169	002	0	1	01	01	H0169_002_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 01:06:21 PM Central Daylight Time	08/03/2018 09:08:10 AM Central Daylight Time	07/31/2018 05:07:24 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0169	002	0	2019	Select Counties in Missouri		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-6886		(844)368-6886		(888)834-3721		(888)834-3721		(844)368-6886		(844)368-6886		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0169	003	0	1	01	01	H0169_003_0	3	1	2	1		05/27/2018	2019.01	05/27/2018 06:03:49 PM Central Daylight Time	08/03/2018 09:08:40 AM Central Daylight Time	07/31/2018 05:08:50 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0169	003	0	2019	Select Counties in Nebraska		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7149		(844)368-7149		(888)834-3721		(888)834-3721		(844)368-7149		(844)368-7149		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	001	0	1	01	01	H0174_001_0	3	1	2	1		08/03/2018	2019.01	08/03/2018 12:06:09 PM Eastern Daylight Time	08/06/2018 06:31:14 PM Eastern Daylight Time	08/01/2018 01:55:29 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.WellCare.com/medicare	WellCare TexanPlus Star (HMO SNP)	01	01		1			H0174	001	0	2019	Select counties in Southeast Texas		2	8998	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9495		(866)530-9495		(866)556-4607		(866)556-4607		(866)530-9495		(866)530-9495		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	002	0	1	01	01	H0174_002_0	5	1				08/09/2018	2019.01	08/09/2018 04:56:53 PM Eastern Daylight Time	08/06/2018 06:33:44 PM Eastern Daylight Time	08/01/2018 01:55:50 PM Eastern Daylight Time			08/09/2018 05:03:07 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	01	01		1			H0174	002	0	2019	Travis, Williamson		2	2675	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	003	0	1	01	01	H0174_003_0	3	1				08/03/2018	2019.01	08/03/2018 12:04:49 PM Eastern Daylight Time	08/06/2018 06:36:24 PM Eastern Daylight Time	08/01/2018 01:56:12 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	01	01		1			H0174	003	0	2019	Bexar, El Paso		2	3566	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	004	0	1	01	01	H0174_004_0	3	1	2	1		08/03/2018	2019.01	08/03/2018 12:09:57 PM Eastern Daylight Time	08/06/2018 06:38:30 PM Eastern Daylight Time	08/01/2018 01:56:34 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H0174	004	0	2019	Select Counties in TX		2	118937	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9495		(866)530-9495		(866)556-4607		(866)556-4607		(866)530-9495		(866)530-9495		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	005	0	1	02	01	H0174_005_0	3	1				08/03/2018	2019.01	08/03/2018 12:03:29 PM Eastern Daylight Time	08/06/2018 06:40:45 PM Eastern Daylight Time	08/01/2018 01:56:54 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H0174	005	0	2019	Select Counties in TX		2	191631	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	006	0	1	01	01	H0174_006_0	3	1	2	1		08/03/2018	2019.01	08/03/2018 12:10:44 PM Eastern Daylight Time	08/06/2018 06:43:08 PM Eastern Daylight Time	08/01/2018 01:57:15 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H0174	006	0	2019	Select Counties in TX		2	44260	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9495		(866)530-9495		(866)556-4607		(866)556-4607		(866)530-9495		(866)530-9495		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	007	0	1	01	01	H0174_007_0	3	1				08/03/2018	2019.01	08/03/2018 12:04:13 PM Eastern Daylight Time	08/06/2018 06:45:31 PM Eastern Daylight Time	08/01/2018 01:57:36 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H0174	007	0	2019	Select Counties in TX		2	83920	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(866)687-8878		(866)687-8878		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0192	001	0	1	48	05	H0192_001_0	6	1				08/29/2018	2019.01	08/29/2018 11:33:31 PM Central Daylight Time					08/30/2018 09:30:54 AM Central Daylight Time	AMERIHEALTH MICHIGAN, INC.	AmeriHealth Caritas VIP Care Plus	www.amerihealthcaritasvipcareplus.com	AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)	05	48		1			H0192	001	0	2019	Wayne and Macomb Counties		2		2			2						www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	(888)667-0318		(888)667-0318		(877)694-2316		(877)694-2316		(888)667-0318		(888)667-0318		(877)694-2316		(877)694-2316		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0216	001	0	1	20	08	H0216_001_0	1	1				05/31/2018	2019.01	05/31/2018 10:27:32 AM Central Daylight Time		05/31/2018 10:15:32 AM Central Daylight Time			05/31/2018 10:54:15 AM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	08	20		1			H0216	001	0	2019	Mills, Harrison, and Pottawattamie Counties		2		2			2						www.immanuel.com	www.immanuel.com												(712)256-7284		(000)000-0000		(712)256-7284												(712)256-7284		(000)000-0000		(712)256-7284																
H0216	002	0	1	20	08	H0216_002_0	1	1				05/31/2018	2019.01	05/31/2018 10:28:07 AM Central Daylight Time		05/31/2018 10:15:32 AM Central Daylight Time			05/31/2018 10:54:15 AM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	08	20		1			H0216	002	0	2019	Counties: PK, MR, SR, BN, DA, MD, JP, WA, MA		2		2			2						www.immanuel.com	www.immanuel.com												(515)270-5000				(515)270-5000												(515)270-5000				(515)270-5000																
H0251	002	0	1	01	01	H0251_002_0	4	1	2	1		06/26/2018	2019.01	06/26/2018 01:36:24 PM Central Daylight Time	08/03/2018 09:11:43 AM Central Daylight Time	07/31/2018 05:10:20 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0251	002	0	2019	Select Counties in Tennessee		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0251	004	0	1	01	01	H0251_004_0	5	1	2	1		06/26/2018	2019.01	06/26/2018 01:37:28 PM Central Daylight Time	08/03/2018 09:12:15 AM Central Daylight Time	08/08/2018 04:47:32 PM Central Daylight Time			08/08/2018 04:56:08 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H0251	004	0	2019	Select Counties in Tennessee		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0251	005	0	1	01	01	H0251_005_0	5	1	2	1		06/25/2018	2019.01	06/25/2018 09:58:27 AM Central Daylight Time	08/03/2018 09:12:46 AM Central Daylight Time	08/08/2018 04:47:54 PM Central Daylight Time			08/08/2018 04:56:08 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE Plus (HMO SNP)	01	01		1			H0251	005	0	2019	Select Counties in Tennessee		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0270	001	0	1	04	01	H0270_001_0	3	1				08/03/2018	2019.01	08/03/2018 12:23:50 PM Eastern Daylight Time	08/06/2018 04:04:25 PM Eastern Daylight Time	08/01/2018 01:57:57 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H0270	001	0	2019	Pulaski and White Counties		2	3414	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fab_search	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	002	0	1	04	01	H0271_002_0	3	1				05/30/2018	2019.01	05/30/2018 12:35:15 PM Central Daylight Time	08/03/2018 09:13:57 AM Central Daylight Time	07/31/2018 05:14:46 PM Central Daylight Time			08/06/2018 09:23:43 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	002	0	2019	Ada, Canyon, Gem, and Payette counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	003	0	1	04	01	H0271_003_0	3	1				05/22/2018	2019.01	05/22/2018 06:44:18 PM Central Daylight Time	08/03/2018 09:14:28 AM Central Daylight Time	07/31/2018 05:16:14 PM Central Daylight Time			08/06/2018 09:23:43 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	003	0	2019	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	004	0	1	04	01	H0271_004_0	3	1				08/02/2018	2019.01	08/02/2018 02:09:51 PM Central Daylight Time	08/03/2018 09:14:59 AM Central Daylight Time	07/31/2018 05:17:44 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	004	0	2019	Cook County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	005	0	1	04	01	H0271_005_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 01:06:58 PM Central Daylight Time	08/03/2018 09:15:30 AM Central Daylight Time	07/31/2018 05:19:12 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H0271	005	0	2019	Select Counties in Indiana		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	006	0	1	04	01	H0271_006_0	4	1	2	1		05/31/2018	2019.01	05/31/2018 05:38:56 PM Central Daylight Time	08/03/2018 09:16:00 AM Central Daylight Time	07/31/2018 05:20:42 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H0271	006	0	2019	Select Counties in Maine		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	007	0	1	04	01	H0271_007_0	4	1				07/12/2018	2019.01	07/12/2018 11:22:53 AM Central Daylight Time	08/03/2018 09:16:30 AM Central Daylight Time	07/31/2018 05:22:10 PM Central Daylight Time			08/06/2018 03:08:50 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	007	0	2019	Select counties in New Hampshire		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	008	0	1	04	01	H0271_008_0	3	1				06/01/2018	2019.01	06/01/2018 01:28:23 PM Central Daylight Time	08/03/2018 09:17:01 AM Central Daylight Time	07/31/2018 05:23:40 PM Central Daylight Time			08/06/2018 09:03:25 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	008	0	2019	Graham, Santa Cruz, and Yavapai counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	010	0	1	04	01	H0271_010_0	3	1				06/01/2018	2019.01	06/01/2018 10:28:11 AM Central Daylight Time	08/03/2018 09:17:31 AM Central Daylight Time	07/31/2018 05:25:08 PM Central Daylight Time			08/06/2018 09:03:25 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	010	0	2019	Select Counties in New Mexico		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	011	0	1	04	01	H0271_011_0	3	1				05/31/2018	2019.01	05/31/2018 01:16:34 PM Central Daylight Time	08/03/2018 09:18:03 AM Central Daylight Time	07/31/2018 05:26:36 PM Central Daylight Time			08/06/2018 09:03:25 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	011	0	2019	Dona Ana, Grant, Hidalgo, Luna, Sierra counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	012	0	1	04	01	H0271_012_0	4	1				07/12/2018	2019.01	07/12/2018 11:24:01 AM Central Daylight Time	08/03/2018 09:18:34 AM Central Daylight Time	07/31/2018 05:28:02 PM Central Daylight Time			08/06/2018 03:08:50 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (PPO)	01	04		1			H0271	012	0	2019	Select counties in Vermont		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	013	0	1	04	01	H0271_013_0	4	1	2	1		05/31/2018	2019.01	05/31/2018 05:38:39 PM Central Daylight Time	08/03/2018 09:19:05 AM Central Daylight Time	07/31/2018 05:29:32 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H0271	013	0	2019	Select Counties in West Virginia		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	014	0	1	04	01	H0271_014_0	4	1	2	1		05/31/2018	2019.01	05/31/2018 05:37:19 PM Central Daylight Time	08/03/2018 09:19:36 AM Central Daylight Time	07/31/2018 05:31:00 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H0271	014	0	2019	State of Connecticut		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0281	001	0	1	48	05	H0281_001_0	3	1				08/22/2018	2019.01	08/22/2018 07:39:20 AM Eastern Daylight Time					08/22/2018 01:41:26 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	IlliniCare Health	mmp.illinicare.com	IlliniCare Health - MMAI (Medicare-Medicaid Plan)	05	48		1			H0281	001	0	2019	Cook, DuPage, Kane, Kankakee, Lake & Will Counties		2	66000	2			2						mmp.illinicare.com/2017/benefits/find-a-doctor-or-pharmacy	mmp.illinicare.com/2017/prescription-drug-part-d/formulary	mmp.illinicare.com/2017/benefits/find-a-doctor-or-pharmacy	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0292	001	0	1	01	01	H0292_001_0	3	1				07/02/2018	2019.01	07/02/2018 12:49:07 PM Eastern Daylight Time	06/01/2018 01:28:54 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H0292	001	0	2019	Select counties in Northern Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0292	002	0	1	01	01	H0292_002_0	4	1				07/18/2018	2019.01	07/18/2018 05:39:17 PM Eastern Daylight Time	06/01/2018 01:32:33 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0292-002 (HMO)	01	01		1			H0292	002	0	2019	Select counties in Northern Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0294	002	0	1	04	01	H0294_002_0	3	1		1		07/12/2018	2019.01	07/12/2018 11:39:36 AM Central Daylight Time	08/03/2018 09:21:04 AM Central Daylight Time	07/31/2018 05:32:30 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Assist (PPO SNP)	01	04		1			H0294	002	0	2019	Select counties in Wisconsin		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	004	0	1	04	01	H0294_004_0	3	1				07/12/2018	2019.01	07/12/2018 11:39:19 AM Central Daylight Time	08/03/2018 09:21:35 AM Central Daylight Time	07/31/2018 05:34:00 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Open (PPO)	01	04		1			H0294	004	0	2019	Select counties in Wisconsin		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	010	0	1	04	01	H0294_010_0	4	1		1		07/12/2018	2019.01	07/12/2018 11:40:25 AM Central Daylight Time	08/03/2018 09:22:05 AM Central Daylight Time	07/31/2018 05:35:30 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Assist (PPO SNP)	01	04		1			H0294	010	0	2019	Select counties in Wisconsin		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	011	0	1	04	01	H0294_011_0	4	1				07/12/2018	2019.01	07/12/2018 11:41:34 AM Central Daylight Time	08/03/2018 09:22:36 AM Central Daylight Time	07/31/2018 05:36:58 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Open (PPO)	01	04		1			H0294	011	0	2019	Select counties in Wisconsin		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	012	0	1	04	01	H0294_012_0	4	1				07/12/2018	2019.01	07/12/2018 11:42:51 AM Central Daylight Time	08/03/2018 09:23:06 AM Central Daylight Time	07/31/2018 05:38:26 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Open Premier (PPO)	01	04		1			H0294	012	0	2019	Select counties in Wisconsin		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	014	0	1	04	01	H0294_014_0	2	1				07/12/2018	2019.01	07/12/2018 11:46:25 AM Central Daylight Time	06/01/2018 05:05:04 PM Central Daylight Time				07/12/2018 05:43:08 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Open Essential (PPO)	01	04		1			H0294	014	0	2019	Western Wisconsin Counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0302	001	0	1	01	01	H0302_001_0	7	1			1	07/16/2018	2019.01	07/16/2018 02:22:13 PM US Mountain Standard Time	08/01/2018 03:54:36 PM US Mountain Standard Time	07/31/2018 03:13:20 PM US Mountain Standard Time			08/07/2018 03:01:49 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Plus (HMO)	01	01		1			H0302	001	0	2019	Maricopa County and partial Pinal County		2	237126	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	006	0	1	01	01	H0302_006_0	6	1			1	07/16/2018	2019.01	07/16/2018 12:31:52 PM US Mountain Standard Time	08/01/2018 03:49:34 PM US Mountain Standard Time	07/31/2018 03:15:10 PM US Mountain Standard Time			08/07/2018 03:01:49 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Classic (HMO)	01	01		1			H0302	006	0	2019	Maricopa County and partial Pinal County		2	278825	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	008	0	1	01	01	H0302_008_0	7	1			2	08/07/2018	2019.01	08/07/2018 08:44:34 AM US Mountain Standard Time	08/07/2018 06:55:20 AM US Mountain Standard Time	07/31/2018 03:16:02 PM US Mountain Standard Time			08/07/2018 03:01:49 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Classic (HMO)	01	01		1			H0302	008	0	2019	Pima County		2	120761	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	009	0	1	01	01	H0302_009_0	7	1			2	08/07/2018	2019.01	08/07/2018 08:51:40 AM US Mountain Standard Time	08/07/2018 06:49:47 AM US Mountain Standard Time	07/31/2018 03:16:46 PM US Mountain Standard Time			08/07/2018 03:01:49 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Standard (HMO)	01	01		1			H0302	009	0	2019	Santa Cruz County		2	3195	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	801	0	1	01	01	H0302_801_0	5	1				06/04/2018	2019.01	06/04/2018 10:12:14 AM US Mountain Standard Time					06/04/2018 03:12:08 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Employer Plan (HMO)	01	01		1			H0302	801	0	2019	Arizona		1	60000	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;14d;14e2;16b;	1					1				
H0321	002	0	1	01	01	H0321_002_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 05:22:04 PM Central Daylight Time	08/03/2018 09:52:17 AM Central Daylight Time	07/31/2018 05:39:54 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0321	002	0	2019	Select counties in Arizona		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0321	004	0	1	01	01	H0321_004_0	2	1	2	1		07/23/2018	2019.01	07/23/2018 04:11:13 PM Central Daylight Time	08/03/2018 09:39:24 AM Central Daylight Time	07/31/2018 05:41:24 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H0321	004	0	2019	Select counties in Arizona		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0332	001	0	1	01	01	H0332_001_0	4	1				07/19/2018	2019.01	07/19/2018 01:52:53 PM Central Daylight Time	06/04/2018 03:55:14 PM Central Daylight Time				07/19/2018 02:12:27 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential (HMO)	01	01		1			H0332	001	0	2019	Harris, Ft Bend, Galveston and Montgomery counties		2	25536	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	002	0	1	01	01	H0332_002_0	6	1				07/19/2018	2019.01	07/19/2018 01:53:06 PM Central Daylight Time	08/06/2018 03:31:56 PM Central Daylight Time	08/06/2018 03:38:40 PM Central Daylight Time			08/07/2018 10:40:40 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx (HMO)	01	01		1			H0332	002	0	2019	Harris, Ft Bend, Galveston and Montgomery counties		2	336016	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	003	0	1	02	01	H0332_003_0	4	1				07/19/2018	2019.01	07/19/2018 01:53:19 PM Central Daylight Time	06/04/2018 04:01:43 PM Central Daylight Time				07/19/2018 02:12:27 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice (HMO-POS)	01	02		1			H0332	003	0	2019	Harris, Ft Bend, Galveston and Montgomery counties		2	12209	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	004	0	1	02	01	H0332_004_0	6	1				07/19/2018	2019.01	07/19/2018 01:53:36 PM Central Daylight Time	08/06/2018 03:34:01 PM Central Daylight Time	08/06/2018 03:40:42 PM Central Daylight Time			08/07/2018 10:40:40 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice (HMO-POS)	01	02		1			H0332	004	0	2019	Harris, Ft Bend, Galveston and Montgomery counties		2	20979	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	801	0	1	01	01	H0332_801_0	1	1				06/01/2018	2019.01	06/01/2018 02:46:01 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	801	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	803	0	1	01	01	H0332_803_0	1	1				06/01/2018	2019.01	06/01/2018 02:48:37 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	803	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	804	0	1	01	01	H0332_804_0	1	1				06/01/2018	2019.01	06/01/2018 02:50:24 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	804	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	805	0	1	01	01	H0332_805_0	1	1				06/01/2018	2019.01	06/01/2018 02:55:48 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	805	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	806	0	1	01	01	H0332_806_0	1	1				06/01/2018	2019.01	06/01/2018 02:56:20 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	806	0	2019	Texas		1	27449	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(877)853-9075		(713)442-2377		(877)853-9075		(713)442-2377										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	807	0	1	01	01	H0332_807_0	1	1				06/01/2018	2019.01	06/01/2018 02:56:42 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	807	0	2019	Texas		1	981	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	808	0	1	01	01	H0332_808_0	1	1				06/01/2018	2019.01	06/01/2018 02:56:58 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	808	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	809	0	1	01	01	H0332_809_0	1	1				06/01/2018	2019.01	06/01/2018 02:57:08 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	809	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	810	0	1	01	01	H0332_810_0	1	1				06/01/2018	2019.01	06/01/2018 02:57:29 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	810	0	2019	Texas		1	885	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	811	0	1	01	01	H0332_811_0	1	1				06/01/2018	2019.01	06/01/2018 02:57:50 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	811	0	2019	Texas		1	68843	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	812	0	1	01	01	H0332_812_0	1	1				06/01/2018	2019.01	06/01/2018 02:58:02 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	812	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	813	0	1	01	01	H0332_813_0	1	1				06/01/2018	2019.01	06/01/2018 02:58:17 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage RX Retiree (HMO)	01	01		1			H0332	813	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	814	0	1	01	01	H0332_814_0	1	1				06/01/2018	2019.01	06/01/2018 02:58:37 PM Central Daylight Time					06/04/2018 04:11:54 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	814	0	2019	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0336	001	0	1	48	05	H0336_001_0	5	1				08/24/2018	2019.01	08/24/2018 12:12:13 PM Eastern Daylight Time					08/24/2018 12:17:31 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Gold Plus Integrated	www.humana.com/medicare/medicaid-dual/illinois/	Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)	05	48		1			H0336	001	0	2019	Chicago Metro Area		2	97440	2			2						www.humana.com/medicare/medicaid-dual/illinois/pharmacy/	www.humana.com/medicare/medicaid-dual/illinois/pharmacy/	www.humana.com/medicare/medicaid-dual/illinois/help/	(800)787-3311		(800)787-3311		(855)635-9561		(855)635-9561		(800)787-3311		(800)787-3311		(855)635-9561		(855)635-9561		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0351	030	0	1	01	01	H0351_030_0	2	1				07/18/2018	2019.01	07/18/2018 03:25:45 PM US Mountain Standard Time	06/03/2018 12:13:38 PM Pacific Daylight Time				07/19/2018 03:20:27 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell Medicare Complement (HMO)	01	01		1			H0351	030	0	2019	Maricopa, Pinal, Santa Cruz, Cochise		2		2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0351	038	0	1	01	01	H0351_038_0	6	1		1		08/03/2018	2019.01	08/03/2018 04:01:21 PM Pacific Daylight Time	08/06/2018 03:57:34 PM Pacific Daylight Time	08/03/2018 05:29:08 PM Pacific Daylight Time			08/06/2018 04:39:56 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell CHF/Diabetes Medicare (HMO SNP)	01	01		1			H0351	038	0	2019	Maricopa and Pinal Counties		2		2			1	4			00000000000000000100		allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	044	1	1	01	01	H0351_044_1	3	1				07/18/2018	2019.01	07/18/2018 09:10:39 AM Pacific Daylight Time	08/03/2018 11:01:20 AM Pacific Daylight Time	08/03/2018 05:31:44 PM Pacific Daylight Time			08/03/2018 10:22:31 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell Medicare (HMO)	01	01		1			H0351	044	1	2019	Pima, Cochise, Santa Cruz, AZ	Pima, AZ	2		2			2						https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	044	2	1	01	01	H0351_044_2	3	1				07/18/2018	2019.01	08/03/2018 10:17:03 PM Pacific Daylight Time	08/03/2018 11:02:12 AM Pacific Daylight Time	08/03/2018 05:35:12 PM Pacific Daylight Time			08/03/2018 10:22:31 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell Medicare (HMO)	01	01		1			H0351	044	2	2019	Pima, Cochise, Santa Cruz, AZ	Cochise, AZ	2		2			2						https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	044	3	1	01	01	H0351_044_3	3	1				07/18/2018	2019.01	08/03/2018 10:17:04 PM Pacific Daylight Time	08/03/2018 11:03:04 AM Pacific Daylight Time	08/03/2018 05:39:22 PM Pacific Daylight Time			08/03/2018 10:22:31 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell Medicare (HMO)	01	01		1			H0351	044	3	2019	Pima, Cochise, Santa Cruz, AZ	Santa Cruz, AZ	2		2			2						https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	050	0	1	01	01	H0351_050_0	3	1				08/01/2018	2019.01	08/01/2018 05:40:20 PM Pacific Daylight Time	08/03/2018 11:03:56 AM Pacific Daylight Time	08/03/2018 05:47:48 PM Pacific Daylight Time			08/03/2018 10:22:31 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell Medicare Essentials II (HMO)	01	01		1			H0351	050	0	2019	Maricopa, Pinal		2		2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	051	0	1	01	01	H0351_051_0	3	1				07/18/2018	2019.01	07/18/2018 09:25:30 AM Pacific Daylight Time	08/03/2018 11:04:48 AM Pacific Daylight Time	08/03/2018 05:51:36 PM Pacific Daylight Time			08/03/2018 10:22:31 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell Medicare Premier (HMO)	01	01		1			H0351	051	0	2019	Maricopa, Pinal		2		2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	801	0	1	01	01	H0351_801_0	1	1				05/29/2018	2019.01	05/29/2018 04:11:33 PM Pacific Daylight Time					06/04/2018 01:13:04 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell CoCare (HMO)	01	01		1			H0351	801	0	2019	All AZ Counties		1	292	2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0351	803	0	1	01	01	H0351_803_0	1	1				05/29/2018	2019.01	05/29/2018 05:27:03 PM Pacific Daylight Time					06/04/2018 01:13:04 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell CoCare (HMO)	01	01		1			H0351	803	0	2019	All AZ Counties		1	100	2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0351	804	0	1	01	01	H0351_804_0	1	1				05/29/2018	2019.01	05/29/2018 04:11:51 PM Pacific Daylight Time					06/04/2018 01:13:04 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell CoCare (HMO)	01	01		1			H0351	804	0	2019	All AZ Counties		1	100	2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0354	001	0	1	01	01	H0354_001_0	6	1				08/02/2018	2019.01	08/02/2018 05:04:31 PM Central Daylight Time	08/01/2018 04:56:22 PM Central Daylight Time	07/31/2018 08:12:33 PM Central Daylight Time			08/06/2018 11:16:24 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0354	001	0	2019	Maricopa Co. and Select Zip Codes in Pinal Co.		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	024	0	1	01	01	H0354_024_0	6	1				08/02/2018	2019.01	08/02/2018 05:05:30 PM Central Daylight Time	08/01/2018 04:57:32 PM Central Daylight Time	07/31/2018 08:12:46 PM Central Daylight Time			08/06/2018 11:16:24 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0354	024	0	2019	Pima County		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)836-8905		(855)836-8905		(800)627-7534		(800)627-7534		(855)836-8905		(855)836-8905		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	027	0	1	01	01	H0354_027_0	6	1		1		08/02/2018	2019.01	08/02/2018 05:06:20 PM Central Daylight Time	08/01/2018 04:59:10 PM Central Daylight Time	07/31/2018 08:12:59 PM Central Daylight Time			08/06/2018 11:16:24 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Achieve Plus (HMO SNP)	01	01		1			H0354	027	0	2019	Maricopa Co. and Select Zip Codes in Pinal Co.		2		2			1	4			00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	028	0	1	01	01	H0354_028_0	6	1				08/02/2018	2019.01	08/02/2018 05:07:09 PM Central Daylight Time	08/01/2018 05:00:36 PM Central Daylight Time	07/31/2018 08:13:12 PM Central Daylight Time			08/06/2018 11:16:24 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Alliance (HMO)	01	01		1			H0354	028	0	2019	Maricopa Co. and select zip codes in Pinal Co.		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	804	0	1	01	01	H0354_804_0	4	1				05/22/2018	2019.01	05/22/2018 11:38:42 AM Central Daylight Time					06/03/2018 09:30:19 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0354	804	0	2019	All Counties in Arizona		1	8268	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;17b;	1	3-1;3-2;3-3;6;7c;7d;7f;7g;7i;8b1;8b2;8b3;9a1;9a2;9d;12;14a;14d;14e2;16b;17a;18a;	1					1				
H0354	805	0	1	01	01	H0354_805_0	4	1				05/23/2018	2019.01	05/23/2018 09:20:22 AM Central Daylight Time					06/03/2018 09:30:19 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H0354	805	0	2019	All Counties in Arizona		1	828	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;17b;	1	3-1;3-2;3-3;6;7c;7d;7f;7g;7i;8b1;8b2;8b3;9a1;9a2;9d;12;14a;14d;14e2;16b;17a;18a;	1					1				
H0390	001	0	1	20	08	H0390_001_0	1	1				05/30/2018	2019.01	05/30/2018 09:11:04 AM Eastern Daylight Time		05/30/2018 09:03:58 AM Eastern Daylight Time			05/30/2018 09:13:37 AM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	http://www.paceswmi.org/	PACE of Southwest Michigan - Dual (PACE)	08	20		1			H0390	001	0	2019	PACE of Southwest Michigan - Dual		2		2			2						www.seniorscript.com	theresesaggau@paceswmi.org										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322																
H0390	002	0	1	20	08	H0390_002_0	1	1				05/30/2018	2019.01	05/30/2018 09:11:38 AM Eastern Daylight Time		05/30/2018 09:03:58 AM Eastern Daylight Time			05/30/2018 09:13:37 AM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	http://www.paceswmi.org/	PACE of Southwest Michigan - Medicare Only (PACE)	08	20		1			H0390	002	0	2019	PACE of Southwest Michigan - Medicare Only		2		2			2						www.seniorscript.com	theresesaggau@paceswmi.org										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322																
H0422	001	0	1	02	01	H0422_001_0	4	1				08/07/2018	2019.01	08/07/2018 12:13:51 PM Central Daylight Time	08/07/2018 11:37:32 AM Central Daylight Time	08/07/2018 09:00:31 AM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	www.ucare.org	Care Core with Fairview & North Memorial (HMO-POS)	01	02		1			H0422	001	0	2019	Twin Cities Metropolitan Area: 8 Counties		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(855)432-7029		(612)676-6545		(877)523-1515		(612)676-3600		(855)432-7029		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H0422	002	0	1	02	01	H0422_002_0	5	1				08/07/2018	2019.01	08/07/2018 12:16:07 PM Central Daylight Time	08/07/2018 09:03:33 AM Central Daylight Time	08/02/2018 03:56:34 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	www.ucare.org	Care Advantage with Fairview & North Memorial (HMO-POS)	01	02		1			H0422	002	0	2019	Twin Cities Metropolitan Area: 8 Counties		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(855)432-7029		(612)676-6545		(877)523-1515		(612)676-3600		(855)432-7029		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H0423	001	0	1	01	01	H0423_001_0	7	1	2	1		08/01/2018	2019.01	08/01/2018 09:40:01 AM Eastern Daylight Time	08/03/2018 01:14:57 PM Eastern Daylight Time	08/03/2018 01:15:40 PM Eastern Daylight Time			08/03/2018 01:32:48 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Advantage Plan (HMO SNP)	01	01		1			H0423	001	0	2019	NYC - All five boroughs		2	100556	2			1	3		2		2	www.caremark.com	https://www.metroplus.org/member-services/formularies	www.metroplusmedicare.org	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0423	004	0	1	01	01	H0423_004_0	4	1				08/02/2018	2019.01	08/02/2018 09:43:37 AM Eastern Daylight Time	08/03/2018 01:15:23 PM Eastern Daylight Time	08/03/2018 01:15:27 PM Eastern Daylight Time			08/06/2018 09:43:53 AM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Platinum (HMO)	01	01		1			H0423	004	0	2019	NYC - All five boroughs		2	603	2			2						www.caremark.com	https://www.metroplus.org/member-services/formularies	www.metroplusmedicare.org	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	001	0	1	01	01	H0432_001_0	4	1				07/12/2018	2019.01	07/12/2018 06:36:17 PM Central Daylight Time	08/03/2018 09:39:55 AM Central Daylight Time	07/31/2018 05:42:56 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0432	001	0	2019	Northern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	002	0	1	01	01	H0432_002_0	4	1				07/10/2018	2019.01	07/10/2018 10:09:42 AM Central Daylight Time	08/03/2018 09:40:26 AM Central Daylight Time	07/31/2018 05:44:36 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0432	002	0	2019	Northern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	003	0	1	01	01	H0432_003_0	4	1				08/02/2018	2019.01	08/02/2018 12:40:35 PM Central Daylight Time	08/03/2018 09:40:57 AM Central Daylight Time	07/31/2018 05:46:18 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0432	003	0	2019	Southern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	004	0	1	01	01	H0432_004_0	4	1				07/10/2018	2019.01	07/10/2018 10:10:23 AM Central Daylight Time	08/03/2018 09:41:28 AM Central Daylight Time	07/31/2018 05:47:58 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0432	004	0	2019	Southern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	005	0	1	01	01	H0432_005_0	4	1				08/02/2018	2019.01	08/02/2018 12:43:11 PM Central Daylight Time	08/03/2018 09:41:59 AM Central Daylight Time	07/31/2018 05:49:42 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0432	005	0	2019	West Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	006	0	1	01	01	H0432_006_0	4	1				07/10/2018	2019.01	07/10/2018 10:10:51 AM Central Daylight Time	08/03/2018 09:42:30 AM Central Daylight Time	07/31/2018 05:51:22 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0432	006	0	2019	West Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	007	0	1	01	01	H0432_007_0	4	1				08/02/2018	2019.01	08/02/2018 12:44:05 PM Central Daylight Time	08/03/2018 09:43:01 AM Central Daylight Time	07/31/2018 05:52:56 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0432	007	0	2019	East Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	008	0	1	01	01	H0432_008_0	4	1				07/10/2018	2019.01	07/10/2018 10:11:27 AM Central Daylight Time	08/03/2018 09:43:32 AM Central Daylight Time	07/31/2018 05:54:30 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0432	008	0	2019	East Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	009	0	1	01	01	H0432_009_0	4	1	2	1		05/29/2018	2019.01	05/29/2018 04:32:12 PM Central Daylight Time	08/03/2018 09:44:04 AM Central Daylight Time	07/31/2018 05:55:56 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0432	009	0	2019	Select Counties in Alabama		2		2			1	3		2		2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	002	0	1	01	01	H0439_002_0	6	1	2	1		08/01/2018	2019.01	08/01/2018 05:09:05 PM Central Daylight Time	08/03/2018 05:12:48 PM Central Daylight Time	07/31/2018 08:13:26 PM Central Daylight Time			08/06/2018 10:45:58 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H0439	002	0	2019	Select Georgia Counties		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	003	1	1	01	01	H0439_003_1	6	1				08/01/2018	2019.01	08/01/2018 05:09:24 PM Central Daylight Time	08/03/2018 05:13:11 PM Central Daylight Time	07/31/2018 08:52:38 PM Central Daylight Time			08/06/2018 10:45:58 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0439	003	1	2019	Georgia	Georgia Preferred	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	003	2	1	01	01	H0439_003_2	6	1				08/01/2018	2019.01	08/01/2018 05:09:40 PM Central Daylight Time	08/03/2018 05:13:34 PM Central Daylight Time	07/31/2018 08:52:51 PM Central Daylight Time			08/06/2018 10:45:58 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0439	003	2	2019	Georgia	Georgia Preferred Select Counties	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	006	0	1	02	01	H0439_006_0	6	1				08/01/2018	2019.01	08/01/2018 05:09:55 PM Central Daylight Time	08/03/2018 05:13:58 PM Central Daylight Time	07/31/2018 08:13:40 PM Central Daylight Time			08/06/2018 10:45:58 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H0439	006	0	2019	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	801	0	1	01	01	H0439_801_0	3	1				05/22/2018	2019.01	05/22/2018 02:49:10 PM Central Daylight Time					06/04/2018 11:02:38 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0439	801	0	2019	Georgia		1	1320	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1					1				
H0439	807	0	1	02	01	H0439_807_0	3	1				05/22/2018	2019.01	05/22/2018 02:55:41 PM Central Daylight Time					06/04/2018 11:02:38 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H0439	807	0	2019	Georgia		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1				
H0473	001	0	1	04	01	H0473_001_0	4	1				07/02/2018	2019.01	07/02/2018 04:26:36 PM Eastern Daylight Time	08/03/2018 03:12:26 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-001 (PPO)	01	04		1			H0473	001	0	2019	Select Counties in Texas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0473	002	0	1	04	01	H0473_002_0	5	1				07/11/2018	2019.01	07/11/2018 01:01:08 PM Eastern Daylight Time	06/01/2018 03:22:40 PM Eastern Daylight Time	08/03/2018 09:20:57 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-002 (PPO)	01	04		1			H0473	002	0	2019	Collin County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0477	001	0	1	20	08	H0477_001_0	1	1				05/31/2018	2019.01	05/31/2018 03:16:20 PM Eastern Daylight Time		05/31/2018 03:02:15 PM Eastern Daylight Time			05/31/2018 03:18:17 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	http://www.serenitypace.org	Serenity PACE Dual (PACE)	08	20		1			H0477	001	0	2019	Serenity Pace Dual		2		2			2						www.omnicare.com	www.pharmastarpbm.com										(413)241-6265		(413)241-6265		(413)241-6265		(413)241-6265										(413)241-6265		(413)241-6265		(413)241-6265		(413)241-6265																
H0477	002	0	1	20	08	H0477_002_0	1	1				05/31/2018	2019.01	05/31/2018 03:16:55 PM Eastern Daylight Time		05/31/2018 03:02:39 PM Eastern Daylight Time			05/31/2018 03:18:17 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	http://www.serenitypace.org	Serenity PACE Medicare only (PACE)	08	20		1			H0477	002	0	2019	Serenity PACE Medicare only		2		2			2						www.omnicare.com	www.pharmastarpbm.com										(413)241-6265		(413)241-6265		(413)304-3977		(413)304-3977										(413)241-6265		(413)241-6265		(413)304-3977		(413)304-3977																
H0480	001	0	1	48	05	H0480_001_0	8	1				08/29/2018	2019.01	08/29/2018 02:31:51 PM Eastern Daylight Time					08/29/2018 02:32:07 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianComplete	www.mhplan.com	MeridianComplete (Medicare-Medicaid Plan)	05	48		1			H0480	001	0	2019	Southwestern Michigan		2	68964	2			2						www.mhplan.com	www.mhplan.com	www.mhplan.com	(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0504	015	0	1	01	01	H0504_015_0	4	1				07/25/2018	2019.01	07/25/2018 02:54:39 PM Pacific Daylight Time	08/03/2018 07:05:27 AM Pacific Daylight Time	08/01/2018 07:42:35 AM Pacific Daylight Time			08/03/2018 02:47:49 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	015	0	2019	Los Angeles (Partial)/Orange Counties		2	588816	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	017	0	1	01	01	H0504_017_0	2	1				05/31/2018	2019.01	05/31/2018 03:01:04 PM Pacific Daylight Time	08/03/2018 07:10:12 AM Pacific Daylight Time	08/01/2018 07:51:19 AM Pacific Daylight Time			08/03/2018 02:47:49 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	017	0	2019	San Bernardino County (Partial)		2	56895	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	021	0	1	01	01	H0504_021_0	2	1				05/30/2018	2019.01	05/30/2018 09:39:42 AM Pacific Daylight Time	08/03/2018 07:13:05 AM Pacific Daylight Time	08/01/2018 07:53:09 AM Pacific Daylight Time			08/03/2018 02:47:49 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus Choice Plan (HMO)	01	01		1			H0504	021	0	2019	Los Angeles (Partial)/Orange Counties CP		2	181111	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	026	0	1	01	01	H0504_026_0	2	1				05/30/2018	2019.01	05/30/2018 09:51:31 AM Pacific Daylight Time	08/03/2018 07:14:22 AM Pacific Daylight Time	08/01/2018 07:54:24 AM Pacific Daylight Time			08/03/2018 02:50:29 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	026	0	2019	Riverside County (Partial)		2	26803	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	028	0	1	01	01	H0504_028_0	4	1				07/09/2018	2019.01	07/09/2018 09:48:49 AM Pacific Daylight Time	08/03/2018 07:15:55 AM Pacific Daylight Time	08/01/2018 07:55:52 AM Pacific Daylight Time			08/03/2018 02:50:29 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	028	0	2019	San Diego County		2	60217	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	029	0	1	01	01	H0504_029_0	4	1				05/30/2018	2019.01	05/30/2018 10:12:19 AM Pacific Daylight Time	08/03/2018 07:17:25 AM Pacific Daylight Time	08/01/2018 07:57:48 AM Pacific Daylight Time			08/03/2018 02:50:29 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	029	0	2019	Ventura County (Partial)		2	34320	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	031	0	1	01	01	H0504_031_0	4	1				05/30/2018	2019.01	05/30/2018 10:17:35 AM Pacific Daylight Time	08/03/2018 07:18:32 AM Pacific Daylight Time	08/01/2018 07:59:07 AM Pacific Daylight Time			08/03/2018 02:52:01 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	031	0	2019	Fresno County		2	13886	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	037	0	1	01	01	H0504_037_0	2	1				05/31/2018	2019.01	05/31/2018 05:03:13 PM Pacific Daylight Time	08/03/2018 07:19:41 AM Pacific Daylight Time	08/01/2018 08:27:42 AM Pacific Daylight Time			08/03/2018 02:52:01 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Trio Medicare (HMO)	01	01		1			H0504	037	0	2019	Sacramento County (partial)		2	38609	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	038	0	1	01	01	H0504_038_0	3	1				05/30/2018	2019.01	05/30/2018 10:30:50 AM Pacific Daylight Time	08/03/2018 07:24:16 AM Pacific Daylight Time	08/01/2018 08:29:17 AM Pacific Daylight Time			08/03/2018 02:52:01 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	038	0	2019	Kern County (partial)		2	60903	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H0504	039	0	1	01	01	H0504_039_0	3	1				05/30/2018	2019.01	05/30/2018 10:38:18 AM Pacific Daylight Time	08/03/2018 07:25:29 AM Pacific Daylight Time	08/01/2018 08:31:06 AM Pacific Daylight Time			08/03/2018 02:53:43 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	039	0	2019	San Luis Obispo/Santa Barbara Counties (partial)		2	25600	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	040	0	1	01	01	H0504_040_0	4	1				07/09/2018	2019.01	07/09/2018 09:50:09 AM Pacific Daylight Time	08/03/2018 08:11:22 AM Pacific Daylight Time	08/01/2018 08:32:57 AM Pacific Daylight Time			08/03/2018 02:53:43 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus Choice Plan (HMO)	01	01		1			H0504	040	0	2019	Riverside/San Bernardino Counties		2	28991	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	803	0	1	01	01	H0504_803_0	1	1				05/21/2018	2019.01	05/21/2018 05:51:47 PM Pacific Daylight Time					05/31/2018 03:02:16 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	803	0	2019	MA-PD Employer Group Plan		1	18785	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2					2				
H0504	804	0	1	01	01	H0504_804_0	1	1				05/21/2018	2019.01	05/21/2018 05:52:02 PM Pacific Daylight Time					05/31/2018 02:57:31 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	804	0	2019	MA-PD Employer Group Plan		1	4436	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2					2				
H0504	805	0	1	01	01	H0504_805_0	1	1				05/21/2018	2019.01	05/21/2018 05:52:10 PM Pacific Daylight Time					05/31/2018 02:52:28 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	805	0	2019	MA-Only Employer Group Plan		1	0	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2					2				
H0523	002	0	1	01	01	H0523_002_0	4	1				08/01/2018	2019.01	08/01/2018 03:52:24 PM Pacific Daylight Time	08/03/2018 09:48:55 AM Eastern Daylight Time	07/31/2018 05:37:31 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	002	0	2019	Los Angeles and Orange Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	022	0	1	01	01	H0523_022_0	3	1				08/01/2018	2019.01	08/01/2018 03:52:59 PM Pacific Daylight Time	08/03/2018 09:51:57 AM Eastern Daylight Time	07/31/2018 05:38:10 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	022	0	2019	Riverside and San Bernardino Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	031	0	1	01	01	H0523_031_0	2	1				08/01/2018	2019.01	08/01/2018 03:53:27 PM Pacific Daylight Time	08/03/2018 09:53:45 AM Eastern Daylight Time	07/31/2018 05:38:48 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	031	0	2019	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	052	0	1	01	01	H0523_052_0	3	1				08/01/2018	2019.01	08/01/2018 03:53:53 PM Pacific Daylight Time	08/03/2018 09:55:46 AM Eastern Daylight Time	07/31/2018 05:39:27 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	052	0	2019	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	061	0	1	01	01	H0523_061_0	2	1				08/01/2018	2019.01	08/01/2018 03:54:14 PM Pacific Daylight Time	08/03/2018 09:57:55 AM Eastern Daylight Time	07/31/2018 05:40:08 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	061	0	2019	Los Angeles and Orange Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	063	0	1	01	01	H0523_063_0	2	1				08/01/2018	2019.01	08/01/2018 03:54:37 PM Pacific Daylight Time	08/03/2018 10:01:33 AM Eastern Daylight Time	07/31/2018 05:40:48 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	063	0	2019	San Bernardino County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	801	0	1	01	01	H0523_801_0	2	1				06/04/2018	2019.01	06/04/2018 11:46:10 AM Eastern Daylight Time					06/04/2018 11:58:16 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0523	801	0	2019	California		1	6320	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H0523	805	0	1	01	01	H0523_805_0	2	1				06/04/2018	2019.01	06/04/2018 11:48:21 AM Eastern Daylight Time					06/04/2018 11:58:16 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H0523	805	0	2019	California		1	7340	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H0524	002	0	2	01	01	H0524_002_0	7	1				07/23/2018	2019.01	07/23/2018 11:30:44 AM Pacific Daylight Time	08/02/2018 03:06:34 PM Pacific Daylight Time	08/02/2018 02:20:00 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only South (HMO)	01	01		2	1		H0524	002	0	2019	Part B Only Southern California Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	003	0	1	01	01	H0524_003_0	6	1				08/02/2018	2019.01	08/02/2018 01:46:05 PM Pacific Daylight Time	08/02/2018 03:08:22 PM Pacific Daylight Time	08/02/2018 02:21:44 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)	01	01		1			H0524	003	0	2019	Los Angeles and Orange Counties Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	008	0	1	01	01	H0524_008_0	6	1				08/02/2018	2019.01	08/02/2018 01:39:20 PM Pacific Daylight Time	08/02/2018 02:43:18 PM Pacific Daylight Time	08/02/2018 01:55:37 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Solano (HMO)	01	01		1			H0524	008	0	2019	Solano County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	010	0	2	01	01	H0524_010_0	8	1				07/23/2018	2019.01	07/23/2018 08:29:59 PM Pacific Daylight Time	08/02/2018 02:45:03 PM Pacific Daylight Time	08/02/2018 01:57:19 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only North (HMO)	01	01		2	1		H0524	010	0	2019	Part B Only Northern California Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	013	0	1	01	01	H0524_013_0	6	1				07/23/2018	2019.01	07/23/2018 11:54:36 AM Pacific Daylight Time	08/02/2018 02:46:47 PM Pacific Daylight Time	08/02/2018 01:59:05 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO)	01	01		1			H0524	013	0	2019	Greater Sac and Sonoma County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	015	0	1	01	01	H0524_015_0	6	1				08/03/2018	2019.01	08/03/2018 11:03:43 AM Pacific Daylight Time	08/02/2018 03:10:04 PM Pacific Daylight Time	08/02/2018 02:23:31 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Inland Empire (HMO)	01	01		1			H0524	015	0	2019	Inland Empire Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	029	0	1	01	01	H0524_029_0	6	1	2	1		08/03/2018	2019.01	08/03/2018 11:24:58 AM Pacific Daylight Time	08/03/2018 03:25:39 PM Pacific Daylight Time	08/03/2018 03:28:02 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)	01	01		1			H0524	029	0	2019	Southern California Plan		2		2			1	3		1		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	030	0	1	01	01	H0524_030_0	7	1	2	1		07/23/2018	2019.01	07/23/2018 12:05:12 PM Pacific Daylight Time	08/02/2018 03:18:23 PM Pacific Daylight Time	08/02/2018 02:32:04 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan North (HMO SNP)	01	01		1			H0524	030	0	2019	Northern California Plan		2		2			1	3		1		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	031	0	1	01	01	H0524_031_0	6	1				08/02/2018	2019.01	08/02/2018 01:39:52 PM Pacific Daylight Time	08/02/2018 02:48:28 PM Pacific Daylight Time	08/02/2018 02:00:55 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Marin San Mateo (HMO)	01	01		1			H0524	031	0	2019	Marin and San Mateo Counties Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	032	0	1	01	01	H0524_032_0	6	1				08/02/2018	2019.01	08/02/2018 01:40:25 PM Pacific Daylight Time	08/02/2018 02:50:11 PM Pacific Daylight Time	08/02/2018 02:02:36 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO)	01	01		1			H0524	032	0	2019	Alameda, Napa, and SF Counties Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	033	0	1	01	01	H0524_033_0	6	1				07/23/2018	2019.01	07/23/2018 12:15:38 PM Pacific Daylight Time	08/02/2018 02:51:44 PM Pacific Daylight Time	08/02/2018 02:04:19 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Contra Costa (HMO)	01	01		1			H0524	033	0	2019	Contra Costa County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	034	0	1	01	01	H0524_034_0	6	1				08/02/2018	2019.01	08/02/2018 02:01:59 PM Pacific Daylight Time	08/02/2018 03:11:40 PM Pacific Daylight Time	08/02/2018 02:25:14 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Ventura (HMO)	01	01		1			H0524	034	0	2019	Ventura County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	035	0	1	01	01	H0524_035_0	6	1				08/02/2018	2019.01	08/02/2018 02:06:02 PM Pacific Daylight Time	08/02/2018 03:13:22 PM Pacific Daylight Time	08/02/2018 02:26:54 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Kern (HMO)	01	01		1			H0524	035	0	2019	Kern County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	036	0	1	01	01	H0524_036_0	7	1				08/02/2018	2019.01	08/02/2018 02:10:22 PM Pacific Daylight Time	08/02/2018 03:15:03 PM Pacific Daylight Time	08/02/2018 02:28:35 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Kern (HMO)	01	01		1			H0524	036	0	2019	Kern County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	037	0	1	01	01	H0524_037_0	6	1				08/02/2018	2019.01	08/02/2018 01:46:52 PM Pacific Daylight Time	08/02/2018 03:16:45 PM Pacific Daylight Time	08/02/2018 02:30:17 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage San Diego (HMO)	01	01		1			H0524	037	0	2019	San Diego County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	038	0	1	01	01	H0524_038_0	6	1				07/23/2018	2019.01	07/23/2018 01:12:38 PM Pacific Daylight Time	08/02/2018 02:53:26 PM Pacific Daylight Time	08/02/2018 02:06:03 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Fresno (HMO)	01	01		1			H0524	038	0	2019	Greater Fresno Area Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	039	0	1	01	01	H0524_039_0	6	1				08/02/2018	2019.01	08/02/2018 01:41:03 PM Pacific Daylight Time	08/02/2018 02:55:06 PM Pacific Daylight Time	08/02/2018 02:07:50 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Santa Clara (HMO)	01	01		1			H0524	039	0	2019	Santa Clara County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	040	0	1	01	01	H0524_040_0	7	1				07/23/2018	2019.01	07/23/2018 01:17:45 PM Pacific Daylight Time	08/02/2018 02:56:43 PM Pacific Daylight Time	08/02/2018 02:09:34 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Stanis (HMO)	01	01		1			H0524	040	0	2019	Stanislaus County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	041	0	1	01	01	H0524_041_0	7	1				08/02/2018	2019.01	08/02/2018 01:42:13 PM Pacific Daylight Time	08/02/2018 02:58:23 PM Pacific Daylight Time	08/02/2018 02:11:16 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Stanis (HMO)	01	01		1			H0524	041	0	2019	Stanislaus County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	042	0	1	01	01	H0524_042_0	6	1				08/02/2018	2019.01	08/02/2018 01:42:41 PM Pacific Daylight Time	08/02/2018 02:59:55 PM Pacific Daylight Time	08/02/2018 02:12:57 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO)	01	01		1			H0524	042	0	2019	San Joaquin County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	043	0	1	01	01	H0524_043_0	6	1				08/02/2018	2019.01	08/02/2018 01:43:14 PM Pacific Daylight Time	08/02/2018 03:01:32 PM Pacific Daylight Time	08/02/2018 02:14:38 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic SnJoaq (HMO)	01	01		1			H0524	043	0	2019	San Joaquin County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	046	0	1	01	01	H0524_046_0	6	1				08/02/2018	2019.01	08/02/2018 01:41:39 PM Pacific Daylight Time	08/02/2018 03:03:15 PM Pacific Daylight Time	08/02/2018 02:16:26 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Fresno (HMO)	01	01		1			H0524	046	0	2019	Greater Fresno Area Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	051	0	1	01	01	H0524_051_0	6	1				07/23/2018	2019.01	07/23/2018 01:39:23 PM Pacific Daylight Time	08/02/2018 03:04:58 PM Pacific Daylight Time	08/02/2018 02:18:19 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO)	01	01		1			H0524	051	0	2019	Greater Sac and Sonoma County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	054	0	1	01	01	H0524_054_0	7	1				08/02/2018	2019.01	08/02/2018 01:44:01 PM Pacific Daylight Time	08/02/2018 03:21:39 PM Pacific Daylight Time	08/02/2018 02:35:36 PM Pacific Daylight Time			08/03/2018 06:11:34 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Santa Cruz (HMO)	01	01		1			H0524	054	0	2019	Santa Cruz County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	801	0	1	01	01	H0524_801_0	1	1				05/10/2018	2019.01	05/10/2018 01:40:02 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	801	0	2019	Southern California Group Part A B		1	12512	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	802	0	1	01	01	H0524_802_0	1	1				05/10/2018	2019.01	05/10/2018 01:40:37 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	802	0	2019	Northern California Group Part A B		1	112227	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	803	0	2	01	01	H0524_803_0	1	1				05/10/2018	2019.01	05/10/2018 01:40:56 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	803	0	2019	Southern California Group B Only		1	48	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	804	0	2	01	01	H0524_804_0	1	1				05/10/2018	2019.01	05/10/2018 01:41:15 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	804	0	2019	Northern California Group B Only		1	108	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	805	0	1	01	01	H0524_805_0	1	1				05/21/2018	2019.01	05/21/2018 11:50:00 AM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	805	0	2019	Southern California Group Part A B Part D		1	2146918	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	806	0	1	01	01	H0524_806_0	1	1				05/10/2018	2019.01	05/10/2018 01:41:44 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	806	0	2019	Northern California Group Part A B Part D		1	2247775	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	807	0	2	01	01	H0524_807_0	1	1				05/10/2018	2019.01	05/10/2018 10:25:40 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	807	0	2019	Southern California Group Part B only  Part D		1	27300	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	808	0	2	01	01	H0524_808_0	1	1				05/10/2018	2019.01	05/10/2018 01:42:22 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	808	0	2019	Northern California Group Part B only Part D		1	5472	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	809	0	1	01	01	H0524_809_0	1	1				05/10/2018	2019.01	05/10/2018 01:42:33 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	809	0	2019	Southern California Plan		1	128756	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	810	0	1	01	01	H0524_810_0	1	1				05/10/2018	2019.01	05/10/2018 01:42:42 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	810	0	2019	Northern California Plan		1	137932	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	811	0	2	01	01	H0524_811_0	1	1				05/10/2018	2019.01	05/10/2018 01:43:02 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	811	0	2019	Southern California Plan		1	328	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	812	0	2	01	01	H0524_812_0	1	1				05/10/2018	2019.01	05/10/2018 01:43:12 PM Pacific Daylight Time					06/01/2018 03:39:40 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	812	0	2019	Northern California Plan		1	84	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0542	001	0	1	20	08	H0542_001_0	2	1				07/26/2018	2019.01	07/26/2018 10:55:41 AM Pacific Daylight Time		07/26/2018 10:13:43 AM Pacific Daylight Time			07/26/2018 10:58:12 AM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	08	20		1			H0542	001	0	2019	Los Angeles County		2		2			2						http://www.altamed.org/	http://www.altamed.org/										(877)462-2582		(323)728-0411		(877)462-2582		(323)728-0411										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H0542	002	0	1	20	08	H0542_002_0	2	1				07/26/2018	2019.01	07/26/2018 10:56:26 AM Pacific Daylight Time		07/26/2018 10:15:58 AM Pacific Daylight Time			07/26/2018 10:58:12 AM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	08	20		1			H0542	002	0	2019	Los Angeles County		2		2			2						http://www.altamed.org/	http://www.altamed.org/										(877)462-2582		(323)728-0411		(877)462-2582		(323)728-0411										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H0543	001	0	1	01	01	H0543_001_0	2	1				08/02/2018	2019.01	08/02/2018 02:59:43 PM Central Daylight Time	08/03/2018 09:38:50 AM Central Daylight Time	07/31/2018 05:57:30 PM Central Daylight Time			08/06/2018 12:21:29 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	001	0	2019	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	013	0	1	01	01	H0543_013_0	2	1				05/29/2018	2019.01	05/29/2018 07:59:23 AM Central Daylight Time	08/03/2018 09:39:30 AM Central Daylight Time	07/31/2018 05:59:00 PM Central Daylight Time			08/06/2018 12:21:29 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Value (HMO)	01	01		1			H0543	013	0	2019	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	019	0	1	01	01	H0543_019_0	2	1				08/02/2018	2019.01	08/02/2018 03:00:20 PM Central Daylight Time	08/03/2018 09:40:05 AM Central Daylight Time	07/31/2018 06:00:34 PM Central Daylight Time			08/06/2018 12:21:29 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	019	0	2019	Kern county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	022	0	1	01	01	H0543_022_0	2	1				05/24/2018	2019.01	05/24/2018 10:22:11 AM Central Daylight Time	08/03/2018 09:40:40 AM Central Daylight Time	07/31/2018 06:02:06 PM Central Daylight Time			08/06/2018 12:21:29 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	022	0	2019	Ventura county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	028	0	1	01	01	H0543_028_0	3	1				07/12/2018	2019.01	07/12/2018 12:56:20 PM Central Daylight Time	08/03/2018 09:41:17 AM Central Daylight Time	07/31/2018 06:03:40 PM Central Daylight Time			08/06/2018 12:21:29 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	028	0	2019	San Mateo county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	029	0	1	01	01	H0543_029_0	2	1				07/12/2018	2019.01	07/12/2018 02:42:47 PM Central Daylight Time	08/03/2018 09:41:54 AM Central Daylight Time	07/31/2018 06:05:10 PM Central Daylight Time			08/06/2018 12:31:03 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	029	0	2019	Santa Clara county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	032	0	1	01	01	H0543_032_0	3	1				07/12/2018	2019.01	07/12/2018 12:56:51 PM Central Daylight Time	08/03/2018 09:42:29 AM Central Daylight Time	07/31/2018 06:06:46 PM Central Daylight Time			08/06/2018 12:31:03 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	032	0	2019	Santa Barbara and San Luis Obispo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	035	0	1	01	01	H0543_035_0	3	1				07/12/2018	2019.01	07/12/2018 12:57:45 PM Central Daylight Time	08/03/2018 09:43:06 AM Central Daylight Time	07/31/2018 06:08:18 PM Central Daylight Time			08/06/2018 12:31:03 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	035	0	2019	Fresno and Madera counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	036	0	1	01	01	H0543_036_0	3	1				07/12/2018	2019.01	07/12/2018 12:58:11 PM Central Daylight Time	08/03/2018 09:43:43 AM Central Daylight Time	07/31/2018 06:09:48 PM Central Daylight Time			08/06/2018 12:31:03 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	036	0	2019	Stanislaus county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	060	0	1	01	01	H0543_060_0	2	1				05/29/2018	2019.01	05/29/2018 07:59:50 AM Central Daylight Time	08/03/2018 09:44:20 AM Central Daylight Time	07/31/2018 06:11:18 PM Central Daylight Time			08/06/2018 12:31:03 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	060	0	2019	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	070	0	1	01	01	H0543_070_0	2	1				05/24/2018	2019.01	05/24/2018 10:30:20 AM Central Daylight Time	08/03/2018 09:44:59 AM Central Daylight Time	07/31/2018 06:12:48 PM Central Daylight Time			08/06/2018 12:39:57 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	070	0	2019	Alameda and Contra Costa counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	086	0	1	01	01	H0543_086_0	2	1				05/24/2018	2019.01	05/24/2018 10:31:10 AM Central Daylight Time	08/03/2018 09:45:37 AM Central Daylight Time	07/31/2018 06:14:16 PM Central Daylight Time			08/06/2018 12:39:57 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	086	0	2019	Nevada county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	089	0	1	01	01	H0543_089_0	3	1				07/12/2018	2019.01	07/12/2018 12:59:01 PM Central Daylight Time	08/03/2018 09:46:14 AM Central Daylight Time	07/31/2018 06:15:46 PM Central Daylight Time			08/06/2018 12:39:57 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	089	0	2019	Placer, Sacramento, and Yolo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	121	0	1	01	01	H0543_121_0	2	1				05/18/2018	2019.01	05/18/2018 09:27:04 AM Central Daylight Time	06/01/2018 03:59:26 PM Central Daylight Time				06/02/2018 11:50:41 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0543	121	0	2019	Kern,LA,Orange,Riverside,San Bernardino,San Diego		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0543	138	0	1	01	01	H0543_138_0	3	1				08/02/2018	2019.01	08/02/2018 03:01:51 PM Central Daylight Time	08/03/2018 09:47:34 AM Central Daylight Time	07/31/2018 06:17:18 PM Central Daylight Time			08/06/2018 12:39:57 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	138	0	2019	Orange county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	140	0	1	01	01	H0543_140_0	4	1				07/12/2018	2019.01	07/12/2018 01:00:09 PM Central Daylight Time	08/03/2018 09:48:12 AM Central Daylight Time	07/31/2018 06:18:46 PM Central Daylight Time			08/06/2018 12:39:57 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	140	0	2019	Amador, El Dorado, Mendocino, Merced, Tulare		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	144	0	1	01	01	H0543_144_0	3	1				08/02/2018	2019.01	08/02/2018 03:02:42 PM Central Daylight Time	08/03/2018 09:48:48 AM Central Daylight Time	07/31/2018 06:20:16 PM Central Daylight Time			08/06/2018 12:45:30 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	144	0	2019	Riverside and San Bernardino counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	145	0	1	01	01	H0543_145_0	3	1				08/02/2018	2019.01	08/02/2018 03:06:40 PM Central Daylight Time	08/03/2018 09:49:29 AM Central Daylight Time	07/31/2018 06:21:52 PM Central Daylight Time			08/06/2018 12:45:30 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp SecureHorizons Plan by UnitedHealthcare (HMO)	01	01		1			H0543	145	0	2019	San Diego county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	146	0	1	01	01	H0543_146_0	4	1				07/12/2018	2019.01	07/12/2018 01:00:43 PM Central Daylight Time	08/03/2018 09:50:05 AM Central Daylight Time	07/31/2018 06:23:26 PM Central Daylight Time			08/06/2018 12:45:30 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	146	0	2019	Placer, Sacramento, and Yolo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	147	0	1	01	01	H0543_147_0	4	1				07/12/2018	2019.01	07/12/2018 01:01:32 PM Central Daylight Time	08/03/2018 09:50:42 AM Central Daylight Time	07/31/2018 06:25:08 PM Central Daylight Time			08/06/2018 12:45:30 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	147	0	2019	Stanislaus county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	148	0	1	01	01	H0543_148_0	4	1				07/12/2018	2019.01	07/12/2018 01:01:54 PM Central Daylight Time	08/03/2018 09:51:19 AM Central Daylight Time	07/31/2018 06:26:36 PM Central Daylight Time			08/06/2018 12:45:30 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	148	0	2019	Sonoma county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	151	0	1	01	01	H0543_151_0	3	1				08/06/2018	2019.01	08/06/2018 09:58:46 AM Central Daylight Time	08/03/2018 09:52:00 AM Central Daylight Time	07/31/2018 06:28:06 PM Central Daylight Time			08/06/2018 12:51:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	151	0	2019	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	152	0	1	01	01	H0543_152_0	3	1				08/02/2018	2019.01	08/02/2018 03:22:16 PM Central Daylight Time	08/03/2018 09:52:41 AM Central Daylight Time	07/31/2018 06:29:36 PM Central Daylight Time			08/06/2018 12:51:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 4 (HMO)	01	01		1			H0543	152	0	2019	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	153	0	1	01	01	H0543_153_0	3	1				05/24/2018	2019.01	05/24/2018 10:45:38 AM Central Daylight Time	08/03/2018 09:53:20 AM Central Daylight Time	07/31/2018 06:31:10 PM Central Daylight Time			08/06/2018 12:51:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	153	0	2019	Los Angeles, Orange, Riverside, and San Bernardino		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	158	0	1	01	01	H0543_158_0	5	1				07/12/2018	2019.01	07/12/2018 01:03:54 PM Central Daylight Time	08/03/2018 09:53:59 AM Central Daylight Time	07/31/2018 06:32:48 PM Central Daylight Time			08/06/2018 12:51:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	158	0	2019	San Mateo County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	163	0	1	01	01	H0543_163_0	5	1				07/12/2018	2019.01	07/12/2018 02:59:19 PM Central Daylight Time	08/03/2018 12:11:04 PM Central Daylight Time	07/31/2018 06:34:20 PM Central Daylight Time			08/06/2018 12:51:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	163	0	2019	Contra Costa County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	164	0	1	01	01	H0543_164_0	4	1				05/29/2018	2019.01	05/29/2018 07:57:23 AM Central Daylight Time	08/03/2018 09:55:16 AM Central Daylight Time	07/31/2018 06:35:52 PM Central Daylight Time			08/06/2018 12:55:33 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	164	0	2019	Los Angeles County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	165	0	1	01	01	H0543_165_0	4	1				05/29/2018	2019.01	05/29/2018 07:57:45 AM Central Daylight Time	08/03/2018 09:55:55 AM Central Daylight Time	07/31/2018 06:37:22 PM Central Daylight Time			08/06/2018 12:55:33 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	165	0	2019	Orange County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	166	0	1	01	01	H0543_166_0	4	1				05/29/2018	2019.01	05/29/2018 07:58:06 AM Central Daylight Time	08/03/2018 09:56:36 AM Central Daylight Time	07/31/2018 06:38:52 PM Central Daylight Time			08/06/2018 12:55:33 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	166	0	2019	Riverside and San Bernardino Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	167	0	1	01	01	H0543_167_0	5	1				07/12/2018	2019.01	07/12/2018 03:04:30 PM Central Daylight Time	08/03/2018 09:57:13 AM Central Daylight Time	07/31/2018 06:40:22 PM Central Daylight Time			08/06/2018 12:55:33 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	167	0	2019	San Luis Obispo County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	168	0	1	01	01	H0543_168_0	4	1				08/02/2018	2019.01	08/02/2018 03:27:57 PM Central Daylight Time	08/03/2018 09:57:49 AM Central Daylight Time	07/31/2018 06:41:52 PM Central Daylight Time			08/06/2018 12:55:33 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Focus (HMO)	01	01		1			H0543	168	0	2019	Los Angeles County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	169	0	1	01	01	H0543_169_0	4	1				08/02/2018	2019.01	08/02/2018 03:28:15 PM Central Daylight Time	08/03/2018 09:58:27 AM Central Daylight Time	07/31/2018 06:43:20 PM Central Daylight Time			08/06/2018 01:00:50 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Focus (HMO)	01	01		1			H0543	169	0	2019	Orange County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	170	0	1	01	01	H0543_170_0	4	1				08/02/2018	2019.01	08/02/2018 03:27:50 PM Central Daylight Time	08/03/2018 09:59:04 AM Central Daylight Time	07/31/2018 06:44:54 PM Central Daylight Time			08/06/2018 01:00:50 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Focus (HMO)	01	01		1			H0543	170	0	2019	Riverside and San Bernardino County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	172	0	1	01	01	H0543_172_0	4	1				05/24/2018	2019.01	05/24/2018 11:00:38 AM Central Daylight Time	08/03/2018 09:59:43 AM Central Daylight Time	07/31/2018 06:46:24 PM Central Daylight Time			08/06/2018 01:00:50 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	172	0	2019	San Diego County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	173	0	1	01	01	H0543_173_0	4	1				05/24/2018	2019.01	05/24/2018 11:00:50 AM Central Daylight Time	08/03/2018 10:00:25 AM Central Daylight Time	07/31/2018 06:47:52 PM Central Daylight Time			08/06/2018 01:00:50 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	173	0	2019	Kern County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	175	0	1	01	01	H0543_175_0	5	1				07/12/2018	2019.01	07/12/2018 03:09:11 PM Central Daylight Time	08/03/2018 10:01:03 AM Central Daylight Time	07/31/2018 06:49:28 PM Central Daylight Time			08/06/2018 01:00:50 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	175	0	2019	San Francisco County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	176	0	1	01	01	H0543_176_0	5	1				07/12/2018	2019.01	07/12/2018 03:09:29 PM Central Daylight Time	08/03/2018 10:01:41 AM Central Daylight Time	07/31/2018 06:51:10 PM Central Daylight Time			08/06/2018 01:06:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	176	0	2019	Marin County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	177	0	1	01	01	H0543_177_0	5	1				07/12/2018	2019.01	07/12/2018 03:09:46 PM Central Daylight Time	08/03/2018 10:02:19 AM Central Daylight Time	07/31/2018 06:52:42 PM Central Daylight Time			08/06/2018 01:06:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	177	0	2019	San Joaquin county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	178	0	1	01	01	H0543_178_0	5	1				07/12/2018	2019.01	07/12/2018 03:10:01 PM Central Daylight Time	08/03/2018 10:02:55 AM Central Daylight Time	07/31/2018 06:54:12 PM Central Daylight Time			08/06/2018 01:06:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	178	0	2019	Santa Cruz County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	179	0	1	01	01	H0543_179_0	5	1				07/12/2018	2019.01	07/12/2018 03:10:19 PM Central Daylight Time	08/03/2018 10:03:35 AM Central Daylight Time	07/31/2018 06:55:48 PM Central Daylight Time			08/06/2018 01:06:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	179	0	2019	Solano County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	180	0	1	01	01	H0543_180_0	4	1				05/21/2018	2019.01	05/21/2018 03:52:58 PM Central Daylight Time	08/03/2018 10:04:14 AM Central Daylight Time	07/31/2018 06:57:20 PM Central Daylight Time			08/06/2018 01:06:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	180	0	2019	Santa Clara County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	181	0	1	01	01	H0543_181_0	4	1				05/21/2018	2019.01	05/21/2018 03:53:26 PM Central Daylight Time	08/03/2018 10:04:52 AM Central Daylight Time	07/31/2018 06:58:54 PM Central Daylight Time			08/06/2018 01:11:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	181	0	2019	Fresno and Madera Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	182	0	1	01	01	H0543_182_0	4	1				05/21/2018	2019.01	05/21/2018 03:53:48 PM Central Daylight Time	08/03/2018 10:05:30 AM Central Daylight Time	07/31/2018 07:00:28 PM Central Daylight Time			08/06/2018 01:11:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	182	0	2019	Stanislaus County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	183	0	1	01	01	H0543_183_0	4	1				05/21/2018	2019.01	05/21/2018 03:54:28 PM Central Daylight Time	08/03/2018 10:06:09 AM Central Daylight Time	07/31/2018 07:01:58 PM Central Daylight Time			08/06/2018 01:11:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	183	0	2019	Alameda and Contra Costa counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	184	0	1	01	01	H0543_184_0	4	1				05/21/2018	2019.01	05/21/2018 03:54:51 PM Central Daylight Time	08/03/2018 10:06:47 AM Central Daylight Time	07/31/2018 07:03:28 PM Central Daylight Time			08/06/2018 01:11:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	184	0	2019	Nevada County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	185	0	1	01	01	H0543_185_0	4	1				05/21/2018	2019.01	05/21/2018 03:55:13 PM Central Daylight Time	08/03/2018 10:07:25 AM Central Daylight Time	07/31/2018 07:05:02 PM Central Daylight Time			08/06/2018 01:11:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	185	0	2019	Select counties in California		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	186	0	1	01	01	H0543_186_0	4	1				05/21/2018	2019.01	05/21/2018 03:56:16 PM Central Daylight Time	08/03/2018 10:08:02 AM Central Daylight Time	07/31/2018 07:06:40 PM Central Daylight Time			08/06/2018 01:11:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	186	0	2019	San Francisco County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	187	0	1	01	01	H0543_187_0	4	1				05/21/2018	2019.01	05/21/2018 03:56:37 PM Central Daylight Time	08/03/2018 10:08:38 AM Central Daylight Time	07/31/2018 07:08:12 PM Central Daylight Time			08/06/2018 01:11:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare MedicareComplete Assure (HMO)	01	01		1			H0543	187	0	2019	San Joaquin County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	802	0	1	01	01	H0543_802_0	1	1				05/22/2018	2019.01	05/22/2018 09:44:11 AM Central Daylight Time					06/02/2018 11:39:32 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	802	0	2019	CA Employer Sponsored Plan Service Area		1	78156	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0543	805	0	1	01	01	H0543_805_0	1	1				05/22/2018	2019.01	05/22/2018 03:33:53 PM Central Daylight Time					06/02/2018 11:39:32 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	805	0	2019	CA Employer Sponsored Plan Service Area		1	192948	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0543	806	0	1	01	01	H0543_806_0	1	1				05/22/2018	2019.01	05/22/2018 04:19:05 PM Central Daylight Time					06/02/2018 11:39:32 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	806	0	2019	CA Employer Sponsored Plan Service Area		1	54240	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0544	002	0	1	01	01	H0544_002_0	8	1				07/26/2018	2019.01	07/26/2018 11:33:26 AM Pacific Daylight Time	08/01/2018 03:24:36 PM Pacific Daylight Time	07/31/2018 03:08:30 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Value Plus (HMO)	01	01		1			H0544	002	0	2019	Los Angeles and Orange Counties		2	253664	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	003	0	1	01	01	H0544_003_0	7	1	2	1		07/26/2018	2019.01	07/26/2018 11:33:17 AM Pacific Daylight Time	08/01/2018 03:27:19 PM Pacific Daylight Time	07/31/2018 03:08:51 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Connect (HMO SNP)	01	01		1			H0544	003	0	2019	Los Angeles County		2	692	2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	004	0	1	01	01	H0544_004_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:04:31 PM Pacific Daylight Time	08/01/2018 03:30:02 PM Pacific Daylight Time	07/31/2018 03:09:13 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Diabetes (HMO SNP)	01	01		1			H0544	004	0	2019	Los Angeles and Orange Counties		2	124880	2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	005	0	1	01	01	H0544_005_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:02:55 PM Pacific Daylight Time	08/01/2018 03:28:38 PM Pacific Daylight Time	07/31/2018 03:09:34 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Care On Site (HMO SNP)	01	01		1			H0544	005	0	2019	Los Angeles and Orange Counties		2	30761	2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	007	0	1	01	01	H0544_007_0	7	1				08/02/2018	2019.01	08/02/2018 10:22:17 AM Pacific Daylight Time	08/01/2018 03:25:59 PM Pacific Daylight Time	07/31/2018 03:09:55 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem StartSmart Plus (HMO)	01	01		1			H0544	007	0	2019	L.A., Orange, San Bernardino Counties		2	22957	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	008	0	1	01	01	H0544_008_0	7	1				07/26/2018	2019.01	07/26/2018 11:35:01 AM Pacific Daylight Time	08/01/2018 03:40:45 PM Pacific Daylight Time	07/31/2018 03:10:15 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Value Plus (HMO)	01	01		1			H0544	008	0	2019	San Bernardino County		2	31534	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	010	0	1	01	01	H0544_010_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:06:25 PM Pacific Daylight Time	08/01/2018 03:42:11 PM Pacific Daylight Time	07/31/2018 03:10:36 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Diabetes (HMO SNP)	01	01		1			H0544	010	0	2019	San Bernardino County		2	21322	2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	012	0	1	01	01	H0544_012_0	8	1				07/26/2018	2019.01	07/26/2018 11:36:45 AM Pacific Daylight Time	08/01/2018 03:50:03 PM Pacific Daylight Time	07/31/2018 03:10:57 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Value Plus (HMO)	01	01		1			H0544	012	0	2019	Santa Clara County, San Benito County		2	16838	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	013	0	1	01	01	H0544_013_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:05:32 PM Pacific Daylight Time	08/01/2018 03:32:41 PM Pacific Daylight Time	07/31/2018 03:11:18 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Heart (HMO SNP)	01	01		1			H0544	013	0	2019	Los Angeles and Orange Counties		2	18176	2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	014	0	1	01	01	H0544_014_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:05:10 PM Pacific Daylight Time	08/01/2018 03:31:21 PM Pacific Daylight Time	07/31/2018 03:11:39 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Breathe (HMO SNP)	01	01		1			H0544	014	0	2019	Los Angeles and Orange Counties		2	15347	2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	015	0	1	01	01	H0544_015_0	9	1		1		08/01/2018	2019.01	08/01/2018 02:25:53 PM Pacific Daylight Time		07/31/2018 03:12:02 PM Pacific Daylight Time		08/01/2018 04:51:29 PM Pacific Daylight Time	08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem ESRD (HMO SNP)	01	01		1			H0544	015	0	2019	Los Angeles and Orange Counties		2	19260	2			1	4			00000000100000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	019	0	1	01	01	H0544_019_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:07:37 PM Pacific Daylight Time	08/01/2018 03:43:30 PM Pacific Daylight Time	07/31/2018 03:12:23 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Breathe (HMO SNP)	01	01		1			H0544	019	0	2019	San Bernardino County		2	4971	2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	020	0	1	01	01	H0544_020_0	9	1		1		08/01/2018	2019.01	08/01/2018 02:26:24 PM Pacific Daylight Time		07/31/2018 03:12:45 PM Pacific Daylight Time		08/01/2018 04:56:03 PM Pacific Daylight Time	08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem ESRD (HMO SNP)	01	01		1			H0544	020	0	2019	San Bernardino County		2	2838	2			1	4			00000000100000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	021	0	1	01	01	H0544_021_0	8	1				07/26/2018	2019.01	07/26/2018 11:43:51 AM Pacific Daylight Time	08/01/2018 03:51:22 PM Pacific Daylight Time	07/31/2018 03:13:07 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem StartSmart Plus (HMO)	01	01		1			H0544	021	0	2019	Santa Clara, Stanislaus, San Benito		2	55475	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	024	0	1	01	01	H0544_024_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:10:43 PM Pacific Daylight Time	08/01/2018 03:56:50 PM Pacific Daylight Time	07/31/2018 03:13:28 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Breathe (HMO SNP)	01	01		1			H0544	024	0	2019	Santa Clara, San Benito County		2	2047	2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	025	0	1	01	01	H0544_025_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:10:05 PM Pacific Daylight Time	08/01/2018 03:55:22 PM Pacific Daylight Time	07/31/2018 03:13:49 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Diabetes (HMO SNP)	01	01		1			H0544	025	0	2019	Santa Clara, San Benito County		2	8964	2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	027	0	1	01	01	H0544_027_0	8	1				07/26/2018	2019.01	07/26/2018 11:46:08 AM Pacific Daylight Time	08/01/2018 04:37:28 PM Pacific Daylight Time	07/31/2018 03:14:10 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Value Plus (HMO)	01	01		1			H0544	027	0	2019	Stanislaus County		2	18727	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	031	0	1	01	01	H0544_031_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:12:55 PM Pacific Daylight Time	08/01/2018 04:40:15 PM Pacific Daylight Time	07/31/2018 03:14:30 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Breathe (HMO SNP)	01	01		1			H0544	031	0	2019	Stanislaus County		2	1830	2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	032	0	1	01	01	H0544_032_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:12:23 PM Pacific Daylight Time	08/01/2018 04:38:47 PM Pacific Daylight Time	07/31/2018 03:14:52 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Diabetes (HMO SNP)	01	01		1			H0544	032	0	2019	Stanislaus County		2	11745	2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	036	0	1	01	01	H0544_036_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:13:32 PM Pacific Daylight Time	08/01/2018 04:41:37 PM Pacific Daylight Time	07/31/2018 03:15:13 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Heart (HMO SNP)	01	01		1			H0544	036	0	2019	Stanislaus County		2	1884	2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	037	0	1	01	01	H0544_037_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:11:51 PM Pacific Daylight Time	08/01/2018 03:58:09 PM Pacific Daylight Time	07/31/2018 03:15:34 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Heart (HMO SNP)	01	01		1			H0544	037	0	2019	Santa Clara, San Benito County		2	1652	2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	038	0	1	01	01	H0544_038_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:08:15 PM Pacific Daylight Time	08/01/2018 03:44:46 PM Pacific Daylight Time	07/31/2018 03:15:55 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Heart (HMO SNP)	01	01		1			H0544	038	0	2019	San Bernardino County		2	3669	2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	041	0	1	01	01	H0544_041_0	8	1	2	1		08/01/2018	2019.01	08/01/2018 02:08:52 PM Pacific Daylight Time	08/01/2018 03:52:41 PM Pacific Daylight Time	07/31/2018 03:16:16 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Connect (HMO SNP)	01	01		1			H0544	041	0	2019	Santa Clara County		2	99	2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	049	0	1	01	01	H0544_049_0	9	1				08/06/2018	2019.01	08/06/2018 02:29:45 PM Pacific Daylight Time	08/06/2018 02:34:33 PM Pacific Daylight Time	07/31/2018 03:16:38 PM Pacific Daylight Time			08/06/2018 03:08:44 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Connect Plus (HMO)	01	01		1			H0544	049	0	2019	Counties: LA, Orange, San Bern., SC, San Benito		2	29912	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	050	0	1	01	01	H0544_050_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:09:27 PM Pacific Daylight Time	08/01/2018 03:53:57 PM Pacific Daylight Time	07/31/2018 03:16:58 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem Care On Site (HMO SNP)	01	01		1			H0544	050	0	2019	Santa Clara County		2	3927	2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	052	0	1	01	01	H0544_052_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 07:03:48 PM Pacific Daylight Time	08/05/2018 07:44:49 PM Pacific Daylight Time	08/01/2018 02:39:57 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0544	052	0	2019	Fresno, Kings, Madera and Tulare Counties		2	17538	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)398-0642		(844)398-0642		(888)230-7338		(888)230-7338		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	053	0	1	01	01	H0544_053_0	9	1	2	1		08/02/2018	2019.01	08/02/2018 05:33:40 PM Pacific Daylight Time	08/05/2018 07:46:02 PM Pacific Daylight Time	08/01/2018 02:41:45 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0544	053	0	2019	Kern County		2	11590	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)398-0642		(844)398-0642		(888)230-7338		(888)230-7338		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	054	0	1	01	01	H0544_054_0	9	1	2	1		08/02/2018	2019.01	08/02/2018 05:35:04 PM Pacific Daylight Time	08/05/2018 07:47:12 PM Pacific Daylight Time	08/01/2018 02:43:27 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0544	054	0	2019	San Francisco and Sacramento Counties		2	75882	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)398-0642		(844)398-0642		(888)230-7338		(888)230-7338		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	055	0	1	01	01	H0544_055_0	9	1	2	1		08/02/2018	2019.01	08/02/2018 05:37:02 PM Pacific Daylight Time	08/05/2018 07:48:14 PM Pacific Daylight Time	08/01/2018 02:45:02 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0544	055	0	2019	Ventura County		2	15279	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)398-0642		(844)398-0642		(888)230-7338		(888)230-7338		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	056	0	1	01	01	H0544_056_0	10	1				08/02/2018	2019.01	08/02/2018 05:43:11 PM Pacific Daylight Time	08/05/2018 07:49:16 PM Pacific Daylight Time	08/01/2018 04:31:45 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	056	0	2019	Fresno, Kings, Madera and Tulare Counties		2	29162	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	057	0	1	01	01	H0544_057_0	11	1				08/02/2018	2019.01	08/02/2018 05:44:15 PM Pacific Daylight Time	08/05/2018 07:50:17 PM Pacific Daylight Time	08/01/2018 04:32:33 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	057	0	2019	San Francisco County		2	25848	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	058	0	1	01	01	H0544_058_0	11	1				08/03/2018	2019.01	08/03/2018 11:13:39 AM Pacific Daylight Time	08/05/2018 07:51:20 PM Pacific Daylight Time	08/01/2018 04:33:21 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	01	01		1			H0544	058	0	2019	Los Angeles County		2	64152	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	059	0	1	01	01	H0544_059_0	10	1				08/03/2018	2019.01	08/03/2018 11:13:56 AM Pacific Daylight Time	08/05/2018 07:52:23 PM Pacific Daylight Time	08/01/2018 04:34:13 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	01	01		1			H0544	059	0	2019	Orange County		2	18580	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	060	3	1	01	01	H0544_060_3	11	1				08/02/2018	2019.01	08/02/2018 05:46:32 PM Pacific Daylight Time	08/05/2018 07:53:28 PM Pacific Daylight Time	08/01/2018 04:35:08 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	060	3	2019	San Bernardino and Riverside Counties	San Bernardino County	2	4660	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	060	4	1	01	01	H0544_060_4	10	1				08/02/2018	2019.01	08/02/2018 05:47:32 PM Pacific Daylight Time	08/05/2018 07:54:32 PM Pacific Daylight Time	08/01/2018 04:36:01 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	060	4	2019	San Bernardino and Riverside Counties	Riverside County	2	7594	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	061	0	1	01	01	H0544_061_0	9	1				08/02/2018	2019.01	08/02/2018 05:48:43 PM Pacific Daylight Time	08/05/2018 07:55:35 PM Pacific Daylight Time	08/01/2018 04:36:44 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	061	0	2019	Orange and Los Angeles Counties		2	13841	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	062	0	1	01	01	H0544_062_0	10	1				08/03/2018	2019.01	08/03/2018 11:13:19 AM Pacific Daylight Time	08/05/2018 07:56:37 PM Pacific Daylight Time	08/01/2018 04:37:29 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	062	0	2019	Kern County		2	44383	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	063	0	1	01	01	H0544_063_0	11	1				08/02/2018	2019.01	08/02/2018 06:01:42 PM Pacific Daylight Time	08/05/2018 07:57:38 PM Pacific Daylight Time	08/01/2018 04:38:17 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	063	0	2019	Ventura County		2	66239	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	064	0	1	01	01	H0544_064_0	10	1				08/06/2018	2019.01	08/06/2018 01:29:14 PM Pacific Daylight Time	08/05/2018 07:58:38 PM Pacific Daylight Time	08/01/2018 04:39:00 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	064	0	2019	Sacramento County		2	91983	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	065	0	1	01	01	H0544_065_0	11	1				08/02/2018	2019.01	08/02/2018 06:04:07 PM Pacific Daylight Time	08/05/2018 07:59:38 PM Pacific Daylight Time	08/01/2018 04:39:42 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	065	0	2019	San Diego County		2	15742	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	066	0	1	01	01	H0544_066_0	11	1				08/03/2018	2019.01	08/03/2018 11:15:06 AM Pacific Daylight Time	08/05/2018 08:00:39 PM Pacific Daylight Time	08/01/2018 04:40:27 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	01	01		1			H0544	066	0	2019	San Bernardino County		2	16703	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	067	0	1	01	01	H0544_067_0	11	1				08/03/2018	2019.01	08/03/2018 11:15:47 AM Pacific Daylight Time	08/05/2018 08:01:39 PM Pacific Daylight Time	08/01/2018 04:41:09 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	01	01		1			H0544	067	0	2019	Riverside County		2	35234	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	069	0	1	01	01	H0544_069_0	10	1				08/02/2018	2019.01	08/02/2018 06:09:40 PM Pacific Daylight Time	08/05/2018 08:02:41 PM Pacific Daylight Time	08/01/2018 04:41:52 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	01	01		1			H0544	069	0	2019	San Francisco County		2	26002	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	070	0	1	01	01	H0544_070_0	9	1				08/02/2018	2019.01	08/02/2018 11:24:23 PM Pacific Daylight Time	08/05/2018 08:03:42 PM Pacific Daylight Time	08/01/2018 02:46:39 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	070	0	2019	San Diego County		2	12743	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)799-9862		(844)799-9862		(888)230-7338		(888)230-7338		(844)799-9863		(844)799-9863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	071	0	1	01	01	H0544_071_0	9	1				08/02/2018	2019.01	08/02/2018 11:25:52 PM Pacific Daylight Time	08/05/2018 08:04:44 PM Pacific Daylight Time	08/01/2018 02:48:21 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	071	0	2019	Riverside and San Bernardino Counties		2	10401	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)799-9862		(844)799-9862		(888)230-7338		(888)230-7338		(844)799-9863		(844)799-9863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	072	0	1	01	01	H0544_072_0	9	1				08/02/2018	2019.01	08/02/2018 11:27:37 PM Pacific Daylight Time	08/05/2018 08:05:45 PM Pacific Daylight Time	08/01/2018 02:50:12 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	072	0	2019	Los Angeles and Orange Counties		2	29072	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)799-9862		(844)799-9862		(888)230-7338		(888)230-7338		(844)799-9863		(844)799-9863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	074	0	1	01	01	H0544_074_0	10	1				08/02/2018	2019.01	08/02/2018 11:30:00 PM Pacific Daylight Time	08/05/2018 08:06:45 PM Pacific Daylight Time	08/01/2018 04:42:37 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	01	01		1			H0544	074	0	2019	Yolo County		2	6250	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	081	0	1	01	01	H0544_081_0	9	1				08/02/2018	2019.01	08/02/2018 11:40:09 PM Pacific Daylight Time	08/05/2018 08:13:46 PM Pacific Daylight Time	08/01/2018 04:45:32 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Extra (HMO)	01	01		1			H0544	081	0	2019	Los Angeles		2	5158	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	087	0	1	01	01	H0544_087_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 12:06:18 AM Pacific Daylight Time	08/05/2018 08:19:46 PM Pacific Daylight Time	08/01/2018 03:04:37 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO SNP)	01	01		1			H0544	087	0	2019	Fresno, Kings, Madera, Tulare		2	2290	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	088	0	1	01	01	H0544_088_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 12:07:36 AM Pacific Daylight Time	08/05/2018 08:20:45 PM Pacific Daylight Time	08/01/2018 03:06:40 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO SNP)	01	01		1			H0544	088	0	2019	Kern		2	781	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	089	0	1	01	01	H0544_089_0	10	1	2	1		08/03/2018	2019.01	08/03/2018 12:10:44 AM Pacific Daylight Time	08/05/2018 08:21:45 PM Pacific Daylight Time	08/01/2018 03:08:11 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO SNP)	01	01		1			H0544	089	0	2019	San Francisco and Sacramento		2	14314	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	090	0	1	01	01	H0544_090_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 12:12:15 AM Pacific Daylight Time	08/05/2018 08:22:43 PM Pacific Daylight Time	08/01/2018 03:10:03 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO SNP)	01	01		1			H0544	090	0	2019	Ventura		2	1561	2			1	3		1		1	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	091	0	1	01	01	H0544_091_0	11	1				08/03/2018	2019.01	08/03/2018 12:12:55 AM Pacific Daylight Time	08/05/2018 08:23:43 PM Pacific Daylight Time	08/01/2018 04:46:17 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	01	01		1			H0544	091	0	2019	San Diego		2	3685	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	801	0	1	01	01	H0544_801_0	1	1				05/30/2018	2019.01	05/30/2018 03:13:09 PM Pacific Daylight Time					05/31/2018 06:19:13 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	caremore.com	Anthem EGWP (HMO)	01	01		1			H0544	801	0	2019	California		1	165	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0544	802	0	1	01	01	H0544_802_0	1	1				05/30/2018	2019.01	05/30/2018 03:13:32 PM Pacific Daylight Time					05/31/2018 06:19:13 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	caremore.com	Anthem EGWP MAPD (HMO)	01	01		1			H0544	802	0	2019	California		1	2083	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	804	0	1	01	01	H0544_804_0	1	1				04/25/2018	2019.01	04/25/2018 05:18:08 PM Pacific Daylight Time					05/31/2018 06:19:13 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	caremore.com	Anthem EGWP MAPD (HMO)	01	01		1			H0544	804	0	2019	California		1	65	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	805	0	1	01	01	H0544_805_0	5	1				09/14/2018	2019.01	09/14/2018 10:31:04 AM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0544	805	0	2019	California, select counties		1	7650	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	806	0	1	01	01	H0544_806_0	4	1				09/14/2018	2019.01	09/14/2018 10:41:17 AM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0544	806	0	2019	California, select counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	807	0	1	01	01	H0544_807_0	4	1				06/19/2018	2019.01	06/19/2018 01:07:44 PM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0544	807	0	2019	California, select counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	808	0	2	01	01	H0544_808_0	4	1				06/19/2018	2019.01	06/19/2018 01:07:48 PM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		2	1		H0544	808	0	2019	Select counties in California		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	809	0	2	01	01	H0544_809_0	4	1				06/19/2018	2019.01	06/19/2018 01:07:27 PM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		2	1		H0544	809	0	2019	Select CA counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	810	0	1	01	01	H0544_810_0	4	1				06/19/2018	2019.01	06/19/2018 01:07:55 PM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0544	810	0	2019	Select CA Counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	811	0	2	01	01	H0544_811_0	4	1				06/19/2018	2019.01	06/19/2018 01:08:09 PM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		2	1		H0544	811	0	2019	Select CA Counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	812	0	2	01	01	H0544_812_0	4	1				06/19/2018	2019.01	06/19/2018 12:49:24 PM Pacific Daylight Time					09/14/2018 10:48:07 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		2	1		H0544	812	0	2019	Select CA counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0545	001	0	1	01	01	H0545_001_0	5	1				07/05/2018	2019.01	07/05/2018 12:03:42 PM Pacific Daylight Time	08/01/2018 03:15:56 PM Pacific Daylight Time	08/01/2018 02:12:46 PM Pacific Daylight Time			08/02/2018 03:08:13 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Service To Seniors (HMO)	01	01		1			H0545	001	0	2019	Counties: LA, RV, OC and SB		2	186930	2			2						http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0545	012	0	1	01	01	H0545_012_0	3	1				07/05/2018	2019.01	07/05/2018 12:04:46 PM Pacific Daylight Time	08/07/2018 08:53:45 AM Pacific Daylight Time	08/07/2018 08:53:45 AM Pacific Daylight Time			08/07/2018 10:06:42 AM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Desert Preferred Choice (HMO)	01	01		1			H0545	012	0	2019	Riverside County		2	78000	2			2						http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(800)251-8191		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0545	014	0	1	01	01	H0545_014_0	6	1				08/01/2018	2019.01	08/01/2018 12:17:34 PM Pacific Daylight Time	08/01/2018 03:20:32 PM Pacific Daylight Time	08/01/2018 12:56:00 PM Pacific Daylight Time			08/02/2018 03:08:13 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Value Preferred Choice (HMO)	01	01		1			H0545	014	0	2019	Counties: LA, SB and Orange		2	4704	2			2						http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0545	801	0	1	01	01	H0545_801_0	1	1				05/16/2018	2019.01	05/16/2018 11:20:12 AM Pacific Daylight Time					06/01/2018 03:40:03 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus I (HMO)	01	01		1			H0545	801	0	2019	Counties: LA, OC, RV SB		1	500	2			2						http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;	2					2				
H0545	802	0	1	01	01	H0545_802_0	1	1				05/16/2018	2019.01	05/16/2018 11:20:29 AM Pacific Daylight Time					06/01/2018 03:40:03 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus II (HMO)	01	01		1			H0545	802	0	2019	Counties: LA, OC, RV SB		1	500	2			2						http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;	2					2				
H0562	009	0	1	01	01	H0562_009_0	3	1				08/02/2018	2019.01	08/02/2018 08:27:30 AM Pacific Daylight Time	08/03/2018 01:03:04 PM Pacific Daylight Time	08/04/2018 10:15:24 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	009	0	2019	San Francisco County		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	012	0	1	01	01	H0562_012_0	3	1				08/02/2018	2019.01	08/02/2018 08:28:02 AM Pacific Daylight Time	08/03/2018 01:04:00 PM Pacific Daylight Time	08/04/2018 10:16:14 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	012	0	2019	San Diego County		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	039	0	1	01	01	H0562_039_0	3	1				07/18/2018	2019.01	07/18/2018 07:24:37 AM Pacific Daylight Time	08/03/2018 01:04:58 PM Pacific Daylight Time	08/04/2018 10:16:18 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	039	0	2019	Yolo county		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	044	0	1	01	01	H0562_044_0	2	1				07/18/2018	2019.01	07/18/2018 07:25:35 AM Pacific Daylight Time	06/03/2018 02:48:08 PM Pacific Daylight Time				07/18/2018 05:05:52 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Green (HMO)	01	01		1			H0562	044	0	2019	L.A., Riverside, S.Bern. Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	045	0	1	01	01	H0562_045_0	2	1				07/18/2018	2019.01	07/18/2018 07:25:40 AM Pacific Daylight Time	06/03/2018 02:49:20 PM Pacific Daylight Time				07/18/2018 05:05:52 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Green (HMO)	01	01		1			H0562	045	0	2019	Ala, Pla, Sac, Sta Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	055	0	1	01	01	H0562_055_0	4	1	2	1		07/18/2018	2019.01	07/18/2018 07:21:48 AM Pacific Daylight Time	08/06/2018 03:00:48 PM Pacific Daylight Time	08/04/2018 10:18:32 AM Pacific Daylight Time			08/06/2018 03:18:52 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Amber I (HMO SNP)	01	01		1			H0562	055	0	2019	L.A., Kern, Org, Riv, SB, Fresno, SD, SF, Tulare		2		2			1	3		2		2	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	068	0	1	01	01	H0562_068_0	3	1				07/18/2018	2019.01	07/18/2018 07:25:49 AM Pacific Daylight Time	08/03/2018 01:06:54 PM Pacific Daylight Time	08/04/2018 10:18:34 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	068	0	2019	Alameda and Stanislaus Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	079	0	1	01	01	H0562_079_0	3	1				08/02/2018	2019.01	08/02/2018 09:01:23 AM Pacific Daylight Time	08/03/2018 01:07:52 PM Pacific Daylight Time	08/04/2018 10:18:34 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	079	0	2019	Kern County		2		2			2						.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	084	0	1	01	01	H0562_084_0	3	1				07/18/2018	2019.01	07/18/2018 07:26:02 AM Pacific Daylight Time	08/03/2018 01:08:46 PM Pacific Daylight Time	08/04/2018 10:18:34 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	084	0	2019	Placer, Sacramento Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	090	0	1	01	01	H0562_090_0	4	1				08/06/2018	2019.01	08/06/2018 09:08:26 AM Pacific Daylight Time	08/03/2018 01:09:44 PM Pacific Daylight Time	08/04/2018 10:18:34 AM Pacific Daylight Time			08/06/2018 10:28:49 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	090	0	2019	Fresno County		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	092	0	1	01	01	H0562_092_0	3	1		1		08/02/2018	2019.01	08/02/2018 08:41:01 AM Pacific Daylight Time	08/03/2018 01:10:38 PM Pacific Daylight Time	08/04/2018 10:18:34 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Jade (HMO SNP)	01	01		1			H0562	092	0	2019	Kern, L. A. and Orange Counties		2		2			1	4			00000000000000000010		ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	097	0	1	01	01	H0562_097_0	3	1				08/02/2018	2019.01	08/02/2018 08:50:03 AM Pacific Daylight Time	08/03/2018 01:11:32 PM Pacific Daylight Time	08/04/2018 10:18:34 AM Pacific Daylight Time			08/04/2018 10:56:05 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	01	01		1			H0562	097	0	2019	San Francisco		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	100	1	1	01	01	H0562_100_1	3	1				07/18/2018	2019.01	07/18/2018 08:57:22 AM Pacific Daylight Time	08/03/2018 01:12:22 PM Pacific Daylight Time	08/04/2018 10:18:34 AM Pacific Daylight Time			08/04/2018 11:21:36 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	100	1	2019	LA, Orange, Riverside and San Bernardino Counties	Los Angeles and Orange Counties	2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	100	2	1	01	01	H0562_100_2	3	1				07/18/2018	2019.01	08/04/2018 11:16:22 AM Pacific Daylight Time	08/03/2018 01:13:12 PM Pacific Daylight Time	08/04/2018 10:18:36 AM Pacific Daylight Time			08/04/2018 11:21:36 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	01	01		1			H0562	100	2	2019	LA, Orange, Riverside and San Bernardino Counties	Riverside and San Bernardino Counties	2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	101	1	1	01	01	H0562_101_1	3	1				08/02/2018	2019.01	08/02/2018 08:50:45 AM Pacific Daylight Time	08/03/2018 01:14:04 PM Pacific Daylight Time	08/04/2018 10:18:36 AM Pacific Daylight Time			08/04/2018 11:21:36 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Gold Select (HMO)	01	01		1			H0562	101	1	2019	LA, Orange, Riverside and San Bernardino Counties	Los Angeles and Orange Counties	2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	101	2	1	01	01	H0562_101_2	3	1				08/02/2018	2019.01	08/04/2018 11:19:06 AM Pacific Daylight Time	08/03/2018 01:14:54 PM Pacific Daylight Time	08/04/2018 10:18:36 AM Pacific Daylight Time			08/04/2018 11:21:36 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Gold Select (HMO)	01	01		1			H0562	101	2	2019	LA, Orange, Riverside and San Bernardino Counties	Riverside and San Bernardino Counties	2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	103	0	1	01	01	H0562_103_0	3	1				08/02/2018	2019.01	08/02/2018 08:51:49 AM Pacific Daylight Time	08/03/2018 01:15:46 PM Pacific Daylight Time	08/04/2018 10:18:36 AM Pacific Daylight Time			08/04/2018 11:50:23 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	01	01		1			H0562	103	0	2019	Yolo County		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	110	1	1	01	01	H0562_110_1	5	1	2	1		07/17/2018	2019.01	07/17/2018 07:19:57 PM Pacific Daylight Time	08/06/2018 03:00:50 PM Pacific Daylight Time	08/04/2018 10:18:36 AM Pacific Daylight Time			08/07/2018 10:42:34 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Amber II (HMO SNP)	01	01		1			H0562	110	1	2019	Parts of Southern and Northern California	Fresno, L.A., Orange, S.D., San Francisco	2		2			1	3		2		2	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/find-doctor	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	110	2	1	01	01	H0562_110_2	5	1	2	1		07/17/2018	2019.01	08/07/2018 10:40:25 AM Pacific Daylight Time	08/06/2018 03:00:50 PM Pacific Daylight Time	08/04/2018 10:18:36 AM Pacific Daylight Time			08/07/2018 10:42:34 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Amber II (HMO SNP)	01	01		1			H0562	110	2	2019	Parts of Southern and Northern California	Kern and Tulare Counties	2		2			1	3		2		2	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/find-doctor	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	110	3	1	01	01	H0562_110_3	5	1	2	1		07/17/2018	2019.01	08/07/2018 10:40:38 AM Pacific Daylight Time	08/06/2018 03:00:50 PM Pacific Daylight Time	08/04/2018 10:18:38 AM Pacific Daylight Time			08/07/2018 10:42:34 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Amber II (HMO SNP)	01	01		1			H0562	110	3	2019	Parts of Southern and Northern California	Riverside and San Bernardino Counties	2		2			1	3		2		2	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/find-doctor	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	111	1	1	01	01	H0562_111_1	5	1				07/18/2018	2019.01	07/18/2018 10:40:02 AM Pacific Daylight Time	08/06/2018 03:00:50 PM Pacific Daylight Time	08/04/2018 10:19:40 AM Pacific Daylight Time			08/07/2018 10:42:34 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire (HMO)	01	01		1			H0562	111	1	2019	Parts of Southern, Northern and Central CA	L.A., Orange and San Diego Counties	2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	111	2	1	01	01	H0562_111_2	5	1				07/18/2018	2019.01	08/07/2018 10:40:49 AM Pacific Daylight Time	08/06/2018 03:00:50 PM Pacific Daylight Time	08/04/2018 10:19:40 AM Pacific Daylight Time			08/07/2018 10:42:34 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire (HMO)	01	01		1			H0562	111	2	2019	Parts of Southern, Northern and Central CA	Kern County	2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	111	3	1	01	01	H0562_111_3	5	1				07/18/2018	2019.01	08/07/2018 10:40:57 AM Pacific Daylight Time	08/06/2018 03:00:52 PM Pacific Daylight Time	08/04/2018 10:19:40 AM Pacific Daylight Time			08/07/2018 10:42:34 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire (HMO)	01	01		1			H0562	111	3	2019	Parts of Southern, Northern and Central CA	Riverside and San Bernardino Counties	2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	112	0	1	01	01	H0562_112_0	3	1				08/02/2018	2019.01	08/02/2018 08:53:13 AM Pacific Daylight Time	08/03/2018 01:21:50 PM Pacific Daylight Time	08/04/2018 10:19:40 AM Pacific Daylight Time			08/04/2018 11:50:23 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	01	01		1			H0562	112	0	2019	Fresno County		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	113	0	1	01	01	H0562_113_0	3	1				08/02/2018	2019.01	08/02/2018 08:53:45 AM Pacific Daylight Time	08/03/2018 01:22:44 PM Pacific Daylight Time	08/04/2018 10:19:42 AM Pacific Daylight Time			08/04/2018 11:50:23 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	01	01		1			H0562	113	0	2019	Alameda County		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	114	0	1	01	01	H0562_114_0	3	1		1		08/02/2018	2019.01	08/02/2018 08:54:22 AM Pacific Daylight Time	08/03/2018 01:23:40 PM Pacific Daylight Time	08/04/2018 10:19:42 AM Pacific Daylight Time			08/04/2018 11:50:23 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Jade (HMO SNP)	01	01		1			H0562	114	0	2019	San Diego		2		2			1	4			00000000000000000010		ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	116	0	1	01	01	H0562_116_0	3	1				08/02/2018	2019.01	08/02/2018 08:42:39 AM Pacific Daylight Time	08/03/2018 01:24:32 PM Pacific Daylight Time	08/06/2018 08:55:20 AM Pacific Daylight Time			08/06/2018 11:51:29 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select II (HMO)	01	01		1			H0562	116	0	2019	Alameda County		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	801	0	1	01	01	H0562_801_0	1	1				06/04/2018	2019.01	06/04/2018 12:14:50 PM Pacific Daylight Time					06/04/2018 03:21:56 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	801	0	2019	California		1	100	2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0562	803	0	1	01	01	H0562_803_0	1	1				06/04/2018	2019.01	06/04/2018 12:14:24 PM Pacific Daylight Time					06/04/2018 03:21:56 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	803	0	2019	California		1	100	2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0562	804	0	1	01	01	H0562_804_0	1	1				06/04/2018	2019.01	06/04/2018 12:14:31 PM Pacific Daylight Time					06/04/2018 03:21:56 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	804	0	2019	California		1	100	2			2						healthnet.com/portal/member/content/iwc/member/unprotected/health_plan/content/group_employer_medica	healthnet.com/portal/member/content/iwc/member/unprotected/health_plan/content/group_employer_medica	healthnet.com/portal/member/content/iwc/member/unprotected/health_plan/content/group_employer_medica	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0571	001	0	1	01	01	H0571_001_0	4	1				05/14/2018	2019.01	05/14/2018 03:06:24 PM Pacific Daylight Time	07/31/2018 04:01:57 PM Pacific Daylight Time	07/31/2018 04:03:39 PM Pacific Daylight Time			08/06/2018 09:29:29 AM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Program (HMO)	01	01		1			H0571	001	0	2019	San Francisco and Northern San Mateo counties		2	24303	2			2						www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		2					2					2	1	01	9a1;	
H0571	005	0	1	01	01	H0571_005_0	3	1	2	1		05/07/2018	2019.01	05/07/2018 01:43:59 PM Pacific Daylight Time	07/31/2018 04:02:52 PM Pacific Daylight Time	07/31/2018 04:04:33 PM Pacific Daylight Time			08/06/2018 09:29:29 AM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Select Program (HMO SNP)	01	01		1			H0571	005	0	2019	San Francisco County		2	32228	2			1	3		2		2	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		2					2					2	2			
H0602	001	0	1	18	06	H0602_001_0	2	2				07/13/2018	2019.01	07/13/2018 08:26:14 AM Mountain Daylight Time					07/13/2018 08:28:53 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	06	18		1			H0602	001	0	2019	Colorado		2	71856	2			2						www.rmhpmedicare.org	www.rmhpmedicare.org		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	003	0	1	18	06	H0602_003_0	2	2				07/13/2018	2019.01	07/13/2018 08:26:54 AM Mountain Daylight Time					07/13/2018 08:28:53 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Plus Plan (Cost)	06	18		1			H0602	003	0	2019	Colorado		2	5964	2			2						www.rmhpmedicare.org	www.rmhpmedicare.org		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	026	0	1	18	06	H0602_026_0	1	2				05/31/2018	2019.01	05/31/2018 11:21:35 AM Mountain Daylight Time					05/31/2018 02:49:11 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Basic Plan (Cost)	06	18		1			H0602	026	0	2019	Colorado		2	16380	2			2						www.rmhpmedicare.org	www.rmhpmedicare.org		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										1	1	1a;5;7d;7e;7f;7g;7h;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;16b;17a;17b;20;	2		2					2				
H0602	027	0	1	18	06	H0602_027_0	2	2				07/13/2018	2019.01	07/13/2018 08:27:37 AM Mountain Daylight Time					07/13/2018 08:28:53 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Thrifty Plan (Cost)	06	18		1			H0602	027	0	2019	Colorado		2	21696	2			2						www.rmhpmedicare.org	www.rmhpmedicare.org		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	040	0	2	18	06	H0602_040_0	1	2				05/31/2018	2019.01	05/31/2018 11:23:56 AM Mountain Daylight Time					05/31/2018 02:49:11 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain B Basic Plan (Cost)	06	18		2	2		H0602	040	0	2019	Colorado		2	4608	2			2						www.rmhpmedicare.org	www.rmhpmedicare.org		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										1	1	5;7d;7e;7f;7g;7h;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;16b;17a;17b;20;	2		2					2				
H0602	041	0	2	18	06	H0602_041_0	1	2				05/31/2018	2019.01	05/31/2018 11:02:09 AM Mountain Daylight Time					05/31/2018 02:49:11 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain B Standard Plan (Cost)	06	18		2	2		H0602	041	0	2019	Colorado		2	12	2			2						www.rmhpmedicare.org	www.rmhpmedicare.org		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	042	0	1	18	06	H0602_042_0	2	2				07/13/2018	2019.01	07/13/2018 08:28:04 AM Mountain Daylight Time					07/13/2018 08:28:53 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Green Plan (Cost)	06	18		1			H0602	042	0	2019	Colorado		2	32124	2			2						www.rmhpmedicare.org	www.rmhpmedicare.org		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	002	0	1	01	01	H0609_002_0	3	1				07/12/2018	2019.01	07/12/2018 11:40:53 AM Central Daylight Time	08/03/2018 12:23:47 PM Central Daylight Time	07/31/2018 07:09:46 PM Central Daylight Time			08/06/2018 08:58:25 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0609	002	0	2019	Select Counties in Colorado		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	007	0	1	01	01	H0609_007_0	3	1				07/12/2018	2019.01	07/12/2018 11:40:27 AM Central Daylight Time	08/03/2018 12:24:25 PM Central Daylight Time	07/31/2018 07:11:22 PM Central Daylight Time			08/06/2018 08:58:25 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0609	007	0	2019	Denver Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	012	0	1	01	01	H0609_012_0	3	1				08/02/2018	2019.01	08/02/2018 12:44:17 PM Central Daylight Time	08/03/2018 12:25:03 PM Central Daylight Time	07/31/2018 07:12:56 PM Central Daylight Time			08/06/2018 08:58:25 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0609	012	0	2019	Denver Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	015	0	1	01	01	H0609_015_0	2	1				07/12/2018	2019.01	07/12/2018 11:42:04 AM Central Daylight Time	06/01/2018 04:12:49 PM Central Daylight Time				07/13/2018 08:12:56 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0609	015	0	2019	Colorado Springs Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	018	0	1	01	01	H0609_018_0	3	1				07/24/2018	2019.01	07/24/2018 12:06:23 PM Central Daylight Time	07/19/2018 02:14:39 PM Central Daylight Time				07/24/2018 12:09:21 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0609	018	0	2019	Denver Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	020	0	1	01	01	H0609_020_0	3	1				08/02/2018	2019.01	08/02/2018 02:59:03 PM Central Daylight Time	08/03/2018 09:11:49 AM Central Daylight Time	07/31/2018 07:14:26 PM Central Daylight Time			08/06/2018 08:58:25 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0609	020	0	2019	Colorado Springs Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	025	0	1	01	01	H0609_025_0	3	1				08/02/2018	2019.01	08/02/2018 12:50:39 PM Central Daylight Time	08/03/2018 09:12:29 AM Central Daylight Time	07/31/2018 07:15:56 PM Central Daylight Time			08/06/2018 08:58:25 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H0609	025	0	2019	Pima County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	026	0	1	01	01	H0609_026_0	3	1				08/02/2018	2019.01	08/02/2018 12:51:35 PM Central Daylight Time	08/03/2018 09:13:09 AM Central Daylight Time	07/31/2018 07:17:30 PM Central Daylight Time			08/06/2018 08:58:25 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0609	026	0	2019	Maricopa and Pinal Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(877)370-2843		(877)370-2843		(800)555-5757		(800)555-5757		(877)370-2843		(877)370-2843		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	027	0	1	01	01	H0609_027_0	3	1				08/02/2018	2019.01	08/02/2018 12:52:20 PM Central Daylight Time	08/03/2018 09:13:49 AM Central Daylight Time	07/31/2018 07:19:00 PM Central Daylight Time			08/06/2018 08:58:25 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0609	027	0	2019	Maricopa County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	028	0	1	01	01	H0609_028_0	3	1				08/02/2018	2019.01	08/02/2018 02:14:37 PM Central Daylight Time	08/03/2018 09:14:30 AM Central Daylight Time	07/31/2018 07:20:30 PM Central Daylight Time			08/06/2018 09:28:02 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0609	028	0	2019	Clark and Nye counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	031	0	1	01	01	H0609_031_0	4	1				07/12/2018	2019.01	07/12/2018 12:30:49 PM Central Daylight Time	08/03/2018 09:15:09 AM Central Daylight Time	07/31/2018 07:22:06 PM Central Daylight Time			08/06/2018 09:28:02 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Premier (HMO)	01	01		1			H0609	031	0	2019	Clark and Nye counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	032	0	1	01	01	H0609_032_0	3	1				08/02/2018	2019.01	08/02/2018 02:15:07 PM Central Daylight Time	08/03/2018 09:15:48 AM Central Daylight Time	07/31/2018 07:23:36 PM Central Daylight Time			08/06/2018 09:28:02 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Focus (HMO)	01	01		1			H0609	032	0	2019	Clark and Nye counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	033	0	1	01	01	H0609_033_0	3	1				07/12/2018	2019.01	07/12/2018 12:31:32 PM Central Daylight Time	08/03/2018 09:16:27 AM Central Daylight Time	07/31/2018 07:25:08 PM Central Daylight Time			08/06/2018 09:28:02 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H0609	033	0	2019	Lyon, Mineral, and Washoe counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	801	0	1	01	01	H0609_801_0	1	1				05/31/2018	2019.01	05/31/2018 08:03:41 AM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	801	0	2019	CO Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	804	0	1	01	01	H0609_804_0	1	1				05/24/2018	2019.01	05/24/2018 10:34:50 AM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	804	0	2019	CO Employer Sponsored Plan Service Area		1	39804	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	805	0	1	01	01	H0609_805_0	1	1				05/24/2018	2019.01	05/24/2018 10:36:29 AM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	805	0	2019	CO Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	806	0	2	01	01	H0609_806_0	1	1				05/24/2018	2019.01	05/24/2018 10:47:40 AM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H0609	806	0	2019	CO Employer Sponsored Plan Service Area		1	1848	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	807	0	1	01	01	H0609_807_0	1	1				05/24/2018	2019.01	05/24/2018 10:49:35 AM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	807	0	2019	Arizona		1	1116	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	808	0	1	01	01	H0609_808_0	1	1				05/24/2018	2019.01	05/24/2018 12:23:04 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	808	0	2019	Arizona		1	301296	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	809	0	1	01	01	H0609_809_0	1	1				05/24/2018	2019.01	05/24/2018 12:24:09 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	809	0	2019	Arizona		1	96	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	810	0	1	01	01	H0609_810_0	1	1				05/30/2018	2019.01	05/30/2018 12:25:43 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	810	0	2019	Clark and Nye Counties		1	24	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	811	0	1	01	01	H0609_811_0	1	1				05/24/2018	2019.01	05/24/2018 12:26:02 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	811	0	2019	Clark and Nye counties		1	7140	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	812	0	1	01	01	H0609_812_0	1	1				05/24/2018	2019.01	05/24/2018 12:26:57 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	812	0	2019	Clark and Nye counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	813	0	1	01	01	H0609_813_0	1	1				05/24/2018	2019.01	05/24/2018 12:27:54 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	813	0	2019	NV Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	814	0	1	01	01	H0609_814_0	1	1				05/24/2018	2019.01	05/24/2018 12:29:03 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	814	0	2019	NV Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	815	0	1	01	01	H0609_815_0	1	1				05/24/2018	2019.01	05/24/2018 12:29:57 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	815	0	2019	NV Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	816	0	1	01	01	H0609_816_0	1	1				05/24/2018	2019.01	05/24/2018 12:30:51 PM Central Daylight Time					06/02/2018 11:48:48 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	816	0	2019	NV Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0613	001	0	1	20	08	H0613_001_0	1	1				05/17/2018	2019.01	05/17/2018 01:41:19 PM Mountain Daylight Time		05/17/2018 11:00:03 AM Mountain Daylight Time			05/17/2018 01:43:43 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge Colorado PACE	www.MyInnovAge.com	Total Longterm Care - Dual eligibles (PACE)	08	20		1			H0613	001	0	2019	Metro Denver,Pueblo,Loveland,Fort Collins,Greeley		2		2			2						http://www.pharmerica.com	http://www.totallongtermcare.org										(855)487-6768		(888)678-6915		(877)277-6163		(303)869-4664										(855)487-6768		(855)487-6768		(877)277-6163		(303)869-4664																
H0613	003	0	1	20	08	H0613_003_0	1	1				05/17/2018	2019.01	05/17/2018 01:41:52 PM Mountain Daylight Time		05/17/2018 10:59:19 AM Mountain Daylight Time			05/17/2018 01:43:43 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge Colorado PACE	www.MyInnovAge.com	Total Longterm Care - Medicare only (PACE)	08	20		1			H0613	003	0	2019	Metro Denver,Pueblo,Loveland,Fort Collins,Greeley		2		2			2						http://www.pharmerica.com	http://www.totallongtermcare.org										(855)487-6768	711	(888)678-6915		(877)277-6163		(303)869-4664										(855)487-6768	711	(855)487-6768	711	(877)277-6163		(303)869-4664																
H0624	001	0	1	01	01	H0624_001_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 01:07:34 PM Central Daylight Time	08/03/2018 10:07:55 AM Central Daylight Time	07/31/2018 07:26:40 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0624	001	0	2019	Denver and Colorado Springs metro areas		2		2			1	3		2		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	013	0	1	01	01	H0630_013_0	16	1				08/03/2018	2019.01	08/03/2018 04:38:14 PM Mountain Daylight Time	08/03/2018 02:07:22 PM Mountain Daylight Time	08/03/2018 02:34:00 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	013	0	2019	Denver Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	014	0	1	01	01	H0630_014_0	8	1	2	1		08/02/2018	2019.01	08/02/2018 11:57:24 AM Mountain Daylight Time	08/03/2018 02:08:38 PM Mountain Daylight Time	08/03/2018 02:36:35 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO SNP)	01	01		1			H0630	014	0	2019	Denver Metro Area		2		2			1	3		2		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	015	0	1	01	01	H0630_015_0	9	1				07/24/2018	2019.01	07/24/2018 08:02:08 AM Mountain Daylight Time	08/03/2018 02:09:55 PM Mountain Daylight Time	08/03/2018 02:38:06 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	015	0	2019	Denver Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	016	0	1	01	01	H0630_016_0	9	1				08/02/2018	2019.01	08/02/2018 11:51:37 AM Mountain Daylight Time	08/03/2018 02:11:19 PM Mountain Daylight Time	08/03/2018 02:39:37 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Gold (HMO)	01	01		1			H0630	016	0	2019	Denver Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	017	0	1	01	01	H0630_017_0	8	1				08/02/2018	2019.01	08/02/2018 12:25:15 PM Mountain Daylight Time	08/03/2018 02:12:38 PM Mountain Daylight Time	08/03/2018 02:41:01 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	017	0	2019	Southern Colorado		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	018	0	1	01	01	H0630_018_0	9	1				08/03/2018	2019.01	08/03/2018 11:03:26 AM Mountain Daylight Time	08/03/2018 02:13:57 PM Mountain Daylight Time	08/03/2018 02:42:22 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	018	0	2019	Southern Colorado		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	020	0	1	01	01	H0630_020_0	9	1				08/02/2018	2019.01	08/02/2018 12:27:18 PM Mountain Daylight Time	08/03/2018 02:15:17 PM Mountain Daylight Time	08/03/2018 02:43:44 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	020	0	2019	Northern Colorado		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	021	0	1	01	01	H0630_021_0	9	1				08/02/2018	2019.01	08/02/2018 12:28:06 PM Mountain Daylight Time	08/03/2018 02:16:36 PM Mountain Daylight Time	08/03/2018 02:45:06 PM Mountain Daylight Time			08/03/2018 04:48:05 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	021	0	2019	Northern Colorado		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	805	0	2	01	01	H0630_805_0	4	1				05/23/2018	2019.01	05/23/2018 08:17:19 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	01	01		2	1		H0630	805	0	2019	Denver Metro Area		1	10474	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7f;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	806	0	2	01	01	H0630_806_0	4	1				05/23/2018	2019.01	05/23/2018 08:17:31 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	01	01		2	1		H0630	806	0	2019	Denver Metro Area		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7f;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	807	0	1	01	01	H0630_807_0	4	1				05/23/2018	2019.01	05/23/2018 08:17:52 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD (HMO)	01	01		1			H0630	807	0	2019	Denver Metro Area		1	275180	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7f;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	808	0	1	01	01	H0630_808_0	4	1				05/23/2018	2019.01	05/23/2018 08:18:05 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Adv_Group_MA only (HMO)	01	01		1			H0630	808	0	2019	Denver Metro Area		1	23	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7f;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	809	0	2	01	01	H0630_809_0	4	1				05/23/2018	2019.01	05/23/2018 08:18:23 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H0630	809	0	2019	Denver Metro Area		1	84	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7f;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	810	0	1	01	01	H0630_810_0	4	1				05/23/2018	2019.01	05/23/2018 08:19:15 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	810	0	2019	Denver Metro Area		1	35546	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7f;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	811	0	2	01	01	H0630_811_0	4	1				05/23/2018	2019.01	05/23/2018 08:19:31 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	01	01		2	1		H0630	811	0	2019	Southern Colorado		1	2182	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	812	0	2	01	01	H0630_812_0	4	1				05/23/2018	2019.01	05/23/2018 08:19:47 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	01	01		2	1		H0630	812	0	2019	Southern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	813	0	1	01	01	H0630_813_0	4	1				05/23/2018	2019.01	05/23/2018 08:20:01 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD (HMO)	01	01		1			H0630	813	0	2019	Southern Colorado		1	36537	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	814	0	1	01	01	H0630_814_0	4	1				05/23/2018	2019.01	05/23/2018 08:20:18 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Adv Group_MA only (HMO)	01	01		1			H0630	814	0	2019	Southern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	815	0	2	01	01	H0630_815_0	4	1				05/23/2018	2019.01	05/23/2018 08:20:37 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H0630	815	0	2019	Southern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	816	0	1	01	01	H0630_816_0	4	1				05/23/2018	2019.01	05/23/2018 08:20:53 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	816	0	2019	Southern Colorado		1	4290	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	817	0	2	01	01	H0630_817_0	4	1				05/23/2018	2019.01	05/23/2018 08:21:09 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MAPD Part B Only (HMO)	01	01		2	1		H0630	817	0	2019	Northern Colorado		1	471	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	818	0	2	01	01	H0630_818_0	4	1				05/23/2018	2019.01	05/23/2018 08:21:27 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA Only Part B Only (HMO)	01	01		2	1		H0630	818	0	2019	Northern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	819	0	1	01	01	H0630_819_0	4	1				05/23/2018	2019.01	05/23/2018 08:21:43 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MAPD (HMO)	01	01		1			H0630	819	0	2019	Northern Colorado		1	12612	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	820	0	1	01	01	H0630_820_0	4	1				05/23/2018	2019.01	05/23/2018 08:22:05 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA Only (HMO)	01	01		1			H0630	820	0	2019	Northern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	821	0	2	01	01	H0630_821_0	4	1				05/23/2018	2019.01	05/23/2018 08:22:21 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B Only with D (HMO)	01	01		2	1		H0630	821	0	2019	Northern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0630	822	0	1	01	01	H0630_822_0	4	1				05/23/2018	2019.01	05/23/2018 08:22:36 AM Mountain Daylight Time					06/04/2018 03:19:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	822	0	2019	Northern Colorado		1	1234	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14e3;	1					2				
H0657	005	0	1	18	06	H0657_005_0	1	2				06/04/2018	2019.01	06/04/2018 12:33:08 PM Mountain Daylight Time					06/04/2018 04:42:01 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Friday Health Plans	www.fridayhealthplans.com	Friday Health Plans Silver SV Plan (Cost)	06	18		1			H0657	005	0	2019	The 6 County San Luis Valley Area		2	400	2			2									(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	006	0	1	18	06	H0657_006_0	1	2				06/04/2018	2019.01	06/04/2018 03:10:05 PM Mountain Daylight Time					06/04/2018 04:42:01 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Friday Health Plans	www.fridayhealthplans.com	Friday Health Plans Gold SV Plan (Cost)	06	18		1			H0657	006	0	2019	The 6 County San Luis Valley Area		2	350	2			2									(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	008	0	1	18	06	H0657_008_0	1	2				06/04/2018	2019.01	06/04/2018 03:28:47 PM Mountain Daylight Time					06/04/2018 04:42:01 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Friday Health Plans	www.fridayhealthplans.com	Friday Health Plans Silver Plan (Cost)	06	18		1			H0657	008	0	2019	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	160	2			2									(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	009	0	1	18	06	H0657_009_0	1	2				06/04/2018	2019.01	06/04/2018 03:43:05 PM Mountain Daylight Time					06/04/2018 04:42:01 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Friday Health Plans	www.fridayhealthplans.com	Friday Health Plans Gold Plan (Cost)	06	18		1			H0657	009	0	2019	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	25	2			2									(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0710	004	0	1	04	01	H0710_004_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:19:17 PM Central Daylight Time	08/03/2018 09:50:25 AM Central Daylight Time	07/31/2018 07:28:14 PM Central Daylight Time			08/06/2018 09:36:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	004	0	2019	Select Counties in Alabama and Florida		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	005	0	1	04	01	H0710_005_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:20:06 PM Central Daylight Time	08/03/2018 09:23:09 AM Central Daylight Time	07/31/2018 07:29:46 PM Central Daylight Time			08/06/2018 09:36:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	005	0	2019	Maricopa, Pima, Pinal, and Yavapai counties		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	007	0	1	04	01	H0710_007_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:21:04 PM Central Daylight Time	08/03/2018 09:23:43 AM Central Daylight Time	07/31/2018 07:31:24 PM Central Daylight Time			08/06/2018 09:36:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	007	0	2019	Denver and Colorado Springs metro areas		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	008	0	1	04	01	H0710_008_0	3	1		1		05/24/2018	2019.01	05/24/2018 01:22:10 PM Central Daylight Time	08/03/2018 09:24:16 AM Central Daylight Time	07/31/2018 07:32:58 PM Central Daylight Time			08/06/2018 09:36:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	008	0	2019	Denver and Colorado Springs metro areas		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	009	0	1	04	01	H0710_009_0	3	1		1		05/24/2018	2019.01	05/24/2018 01:22:30 PM Central Daylight Time	08/03/2018 09:24:49 AM Central Daylight Time	07/31/2018 07:34:28 PM Central Daylight Time			08/06/2018 09:36:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	009	0	2019	Fairfield, Hartford, and New Haven counties		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	010	0	1	04	01	H0710_010_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:23:56 PM Central Daylight Time	08/03/2018 09:25:22 AM Central Daylight Time	07/31/2018 07:36:02 PM Central Daylight Time			08/06/2018 09:36:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	010	0	2019	Select Counties in Florida		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	012	0	1	04	01	H0710_012_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:25:13 PM Central Daylight Time	08/03/2018 09:25:55 AM Central Daylight Time	07/31/2018 07:37:32 PM Central Daylight Time			08/06/2018 09:36:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	012	0	2019	Select Counties in Florida		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	013	0	1	04	01	H0710_013_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:26:04 PM Central Daylight Time	08/03/2018 09:26:29 AM Central Daylight Time	07/31/2018 05:40:34 PM Central Daylight Time			08/06/2018 09:52:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	013	0	2019	Select Counties in Indiana		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	015	0	1	04	01	H0710_015_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:26:40 PM Central Daylight Time	08/03/2018 09:27:01 AM Central Daylight Time	07/31/2018 05:41:00 PM Central Daylight Time			08/06/2018 09:52:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	015	0	2019	Select Counties in Maine and New Hampshire		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	016	0	1	04	01	H0710_016_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:27:22 PM Central Daylight Time	08/03/2018 09:27:35 AM Central Daylight Time	07/31/2018 05:41:24 PM Central Daylight Time			08/06/2018 09:52:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	016	0	2019	St. Louis and Springfield Metro areas		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	017	0	1	04	01	H0710_017_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:29:03 PM Central Daylight Time	08/03/2018 09:28:12 AM Central Daylight Time	07/31/2018 05:41:50 PM Central Daylight Time			08/06/2018 09:52:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	017	0	2019	Select Counties in Pennsylvania, State of Delaware		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	020	0	1	04	01	H0710_020_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:29:49 PM Central Daylight Time	08/03/2018 09:28:51 AM Central Daylight Time	07/31/2018 05:42:16 PM Central Daylight Time			08/06/2018 09:52:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	020	0	2019	Select counties in Texas		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	026	0	1	04	01	H0710_026_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:30:30 PM Central Daylight Time	08/03/2018 09:29:29 AM Central Daylight Time	07/31/2018 05:42:40 PM Central Daylight Time			08/06/2018 09:52:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	026	0	2019	Connecticut and Select counties in New Jersey		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	027	0	1	04	01	H0710_027_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:33:45 PM Central Daylight Time	08/03/2018 09:30:07 AM Central Daylight Time	07/31/2018 05:43:06 PM Central Daylight Time			08/06/2018 09:52:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	027	0	2019	Select Counties in Ohio		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	030	0	1	04	01	H0710_030_0	3	1		1		05/24/2018	2019.01	05/24/2018 01:23:43 PM Central Daylight Time	08/03/2018 09:30:47 AM Central Daylight Time	07/31/2018 05:43:30 PM Central Daylight Time			08/06/2018 09:59:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	030	0	2019	Select counties in Washington		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	031	0	1	04	01	H0710_031_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:34:35 PM Central Daylight Time	08/03/2018 09:31:25 AM Central Daylight Time	07/31/2018 05:43:54 PM Central Daylight Time			08/06/2018 09:59:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	031	0	2019	Select counties in Washington		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	032	0	1	04	01	H0710_032_0	5	1		1		08/10/2018	2019.01	08/10/2018 10:09:39 AM Central Daylight Time	08/10/2018 09:45:34 AM Central Daylight Time	07/31/2018 05:44:20 PM Central Daylight Time			08/10/2018 02:33:04 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	032	0	2019	Select Counties in Maryland and Virginia		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	033	0	1	04	01	H0710_033_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:36:26 PM Central Daylight Time	08/03/2018 09:32:41 AM Central Daylight Time	07/31/2018 05:44:44 PM Central Daylight Time			08/06/2018 09:59:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	033	0	2019	Select Counties in Georgia		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	034	0	1	04	01	H0710_034_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:38:34 PM Central Daylight Time	08/03/2018 09:33:20 AM Central Daylight Time	07/31/2018 05:45:10 PM Central Daylight Time			08/06/2018 09:59:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	034	0	2019	Select Counties in North Carolina		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	035	0	1	04	01	H0710_035_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:39:21 PM Central Daylight Time	08/03/2018 09:34:00 AM Central Daylight Time	07/31/2018 05:45:34 PM Central Daylight Time			08/06/2018 09:59:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	035	0	2019	State of Rhode Island		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	036	0	1	04	01	H0710_036_0	5	1		1		08/10/2018	2019.01	08/10/2018 10:10:16 AM Central Daylight Time	08/10/2018 09:42:12 AM Central Daylight Time	07/31/2018 05:45:58 PM Central Daylight Time			08/10/2018 02:33:04 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	036	0	2019	Select Counties in Oregon		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	037	0	1	04	01	H0710_037_0	3	1		1		05/24/2018	2019.01	05/24/2018 01:24:34 PM Central Daylight Time	07/13/2018 01:31:26 PM Central Daylight Time	07/12/2018 11:58:14 AM Central Daylight Time			07/16/2018 03:57:55 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 2 (PPO SNP)	01	04		1			H0710	037	0	2019	Select Counties in Oregon		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	038	0	1	04	01	H0710_038_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:41:03 PM Central Daylight Time	07/13/2018 01:32:01 PM Central Daylight Time	07/12/2018 11:58:46 AM Central Daylight Time			07/16/2018 03:57:55 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	038	0	2019	Hillsborough County		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	039	0	1	04	01	H0710_039_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:43:08 PM Central Daylight Time	07/13/2018 01:32:36 PM Central Daylight Time	07/12/2018 11:59:16 AM Central Daylight Time			07/16/2018 03:57:55 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	039	0	2019	Chicago Metro area		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	040	0	1	04	01	H0710_040_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:43:52 PM Central Daylight Time	07/13/2018 01:33:12 PM Central Daylight Time	07/12/2018 11:59:48 AM Central Daylight Time			07/16/2018 03:57:55 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	040	0	2019	Boston, Springfield, and Worcester Metro Areas		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	041	0	1	04	01	H0710_041_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:44:35 PM Central Daylight Time	07/13/2018 01:33:47 PM Central Daylight Time	07/12/2018 12:00:20 PM Central Daylight Time			07/16/2018 03:57:55 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	041	0	2019	Select Counties in Twin Cities Metro Area		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	042	0	1	04	01	H0710_042_0	3	1		1		05/30/2018	2019.01	05/30/2018 09:54:21 AM Central Daylight Time	08/03/2018 09:38:00 AM Central Daylight Time	07/12/2018 12:00:52 PM Central Daylight Time			07/16/2018 03:57:55 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	042	0	2019	Select Counties in Wisconsin		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	043	0	1	04	01	H0710_043_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:45:30 PM Central Daylight Time	08/03/2018 09:38:34 AM Central Daylight Time	07/31/2018 05:48:54 PM Central Daylight Time			07/16/2018 03:57:55 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO SNP)	01	04		1			H0710	043	0	2019	Select Counties in Wisconsin		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	801	0	1	04	01	H0710_801_0	1	1				05/31/2018	2019.01	05/31/2018 08:22:06 AM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	801	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	802	0	1	04	01	H0710_802_0	1	1				05/30/2018	2019.01	05/30/2018 12:26:58 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	802	0	2019	Nationwide		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0710	803	0	1	04	01	H0710_803_0	1	1				05/30/2018	2019.01	05/30/2018 12:27:36 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	803	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	804	0	2	04	01	H0710_804_0	1	1				05/30/2018	2019.01	05/30/2018 12:27:58 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	804	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	805	0	2	04	01	H0710_805_0	1	1				05/30/2018	2019.01	05/30/2018 12:28:33 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	805	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0710	806	0	2	04	01	H0710_806_0	1	1				05/30/2018	2019.01	05/30/2018 12:28:59 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	806	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	807	0	1	04	01	H0710_807_0	1	1				05/30/2018	2019.01	05/30/2018 12:29:21 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	807	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	808	0	1	04	01	H0710_808_0	1	1				05/30/2018	2019.01	05/30/2018 12:29:49 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	808	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	809	0	1	04	01	H0710_809_0	1	1				05/30/2018	2019.01	05/30/2018 12:30:13 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	809	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	810	0	1	04	01	H0710_810_0	1	1				05/30/2018	2019.01	05/30/2018 12:30:34 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	810	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0710	811	0	1	04	01	H0710_811_0	1	1				05/30/2018	2019.01	05/30/2018 12:32:28 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	811	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	812	0	2	04	01	H0710_812_0	1	1				05/30/2018	2019.01	05/30/2018 12:33:14 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	812	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	813	0	2	04	01	H0710_813_0	1	1				05/30/2018	2019.01	05/30/2018 12:33:42 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	813	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0710	814	0	2	04	01	H0710_814_0	1	1				05/30/2018	2019.01	05/30/2018 12:34:05 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	814	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	815	0	1	04	01	H0710_815_0	1	1				05/30/2018	2019.01	05/30/2018 12:34:30 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	815	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	816	0	1	04	01	H0710_816_0	1	1				05/30/2018	2019.01	05/30/2018 12:35:03 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	816	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	817	0	1	04	01	H0710_817_0	1	1				05/30/2018	2019.01	05/30/2018 12:35:24 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	817	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0710	818	0	1	04	01	H0710_818_0	1	1				05/30/2018	2019.01	05/30/2018 12:35:44 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	818	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	819	0	1	04	01	H0710_819_0	1	1				05/30/2018	2019.01	05/30/2018 12:36:09 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	819	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	820	0	1	04	01	H0710_820_0	1	1				05/30/2018	2019.01	05/30/2018 12:36:29 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	820	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	821	0	1	04	01	H0710_821_0	1	1				05/30/2018	2019.01	05/30/2018 12:36:49 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	821	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	822	0	1	04	01	H0710_822_0	1	1				05/30/2018	2019.01	05/30/2018 12:37:14 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	822	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	823	0	1	04	01	H0710_823_0	1	1				05/30/2018	2019.01	05/30/2018 12:37:40 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	823	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	824	0	2	04	01	H0710_824_0	1	1				05/30/2018	2019.01	05/30/2018 12:38:07 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	824	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	825	0	1	04	01	H0710_825_0	1	1				05/30/2018	2019.01	05/30/2018 12:38:27 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	825	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0710	826	0	1	04	01	H0710_826_0	1	1				05/30/2018	2019.01	05/30/2018 12:40:03 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	826	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	827	0	1	04	01	H0710_827_0	1	1				05/30/2018	2019.01	05/30/2018 12:40:43 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	827	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	829	0	1	04	01	H0710_829_0	1	1				05/30/2018	2019.01	05/30/2018 12:41:18 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	829	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	830	0	1	04	01	H0710_830_0	1	1				05/30/2018	2019.01	05/30/2018 12:41:40 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	830	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0710	831	0	1	04	01	H0710_831_0	1	1				05/30/2018	2019.01	05/30/2018 12:42:02 PM Central Daylight Time					06/02/2018 12:23:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	831	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0712	005	0	1	01	01	H0712_005_0	3	1	2	1		05/27/2018	2019.01	05/27/2018 12:47:40 PM Eastern Daylight Time	08/06/2018 04:05:08 PM Eastern Daylight Time	08/01/2018 01:58:18 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H0712	005	0	2019	Fairfield, Hartford Counties		2	39942	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)635-7047		(866)635-7047		(866)527-0056		(866)527-0056		(866)635-7047		(866)635-7047		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	019	0	1	01	01	H0712_019_0	3	1				08/03/2018	2019.01	08/03/2018 12:12:28 PM Eastern Daylight Time	08/06/2018 04:05:49 PM Eastern Daylight Time	08/01/2018 01:58:39 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H0712	019	0	2019	Select counties in CT		2	37274	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	020	0	1	02	01	H0712_020_0	3	1				05/30/2018	2019.01	05/30/2018 12:55:28 PM Eastern Daylight Time	08/06/2018 04:06:30 PM Eastern Daylight Time	08/01/2018 01:59:00 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO-POS)	01	02		1			H0712	020	0	2019	Fairfield, Hartford,Tolland Counties		2	23378	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	021	0	1	01	01	H0712_021_0	3	1				08/03/2018	2019.01	08/03/2018 12:12:03 PM Eastern Daylight Time	08/06/2018 04:07:13 PM Eastern Daylight Time	08/01/2018 01:59:21 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Preferred (HMO)	01	01		1			H0712	021	0	2019	Select Counties in CT		2	1944	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	022	0	1	01	01	H0712_022_0	3	1				08/03/2018	2019.01	08/03/2018 04:01:07 PM Eastern Daylight Time	08/06/2018 04:07:53 PM Eastern Daylight Time	08/01/2018 01:59:41 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H0712	022	0	2019	Select Counties in NC		2	4560	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)655-2425		(877)655-2425		(866)527-0056		(866)527-0056		(877)655-2425		(877)655-2425		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	023	0	1	01	01	H0712_023_0	3	1				08/03/2018	2019.01	08/03/2018 03:59:47 PM Eastern Daylight Time	08/06/2018 04:08:36 PM Eastern Daylight Time	08/01/2018 02:00:03 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H0712	023	0	2019	Select Counties in NC		2	2740	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)655-2425		(877)655-2425		(866)527-0056		(866)527-0056		(877)655-2425		(877)655-2425		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	024	0	1	01	01	H0712_024_0	3	1				08/03/2018	2019.01	08/03/2018 03:59:09 PM Eastern Daylight Time	08/06/2018 04:09:20 PM Eastern Daylight Time	08/01/2018 02:00:23 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H0712	024	0	2019	Select Counties in NC		2	5772	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)655-2425		(877)655-2425		(866)527-0056		(866)527-0056		(877)655-2425		(877)655-2425		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	025	0	1	01	01	H0712_025_0	4	1	2	1		07/12/2018	2019.01	07/12/2018 03:15:04 PM Eastern Daylight Time	08/06/2018 04:10:02 PM Eastern Daylight Time	08/01/2018 02:00:44 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H0712	025	0	2019	Select Counties in NC		2	5919	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)655-2422		(877)655-2422		(866)527-0056		(866)527-0056		(877)655-2422		(877)655-2422		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	028	0	1	01	01	H0712_028_0	4	1	2	1		07/12/2018	2019.01	07/12/2018 03:26:26 PM Eastern Daylight Time	08/06/2018 04:10:43 PM Eastern Daylight Time	08/01/2018 02:01:05 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H0712	028	0	2019	Select Counties in CT		2	5174	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)635-7047		(866)635-7047		(866)527-0056		(866)527-0056		(866)635-7047		(866)635-7047		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	001	0	1	01	01	H0724_001_0	5	1				08/02/2018	2019.01	08/02/2018 12:29:55 PM Eastern Daylight Time	08/04/2018 08:33:52 AM Eastern Daylight Time	08/04/2018 08:33:53 AM Eastern Daylight Time			08/04/2018 09:18:31 AM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Medicare (HMO)	01	01		1			H0724	001	0	2019	Northeast Ohio		2		2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	002	0	1	01	01	H0724_002_0	5	1				08/02/2018	2019.01	08/02/2018 08:22:22 AM Eastern Daylight Time	08/04/2018 08:33:55 AM Eastern Daylight Time	08/04/2018 08:33:56 AM Eastern Daylight Time			08/04/2018 09:18:31 AM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Medicare (HMO)	01	01		1			H0724	002	0	2019	Southwest Ohio		2		2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	003	0	1	01	01	H0724_003_0	5	1				08/02/2018	2019.01	08/02/2018 08:23:02 AM Eastern Daylight Time	08/04/2018 08:33:57 AM Eastern Daylight Time	08/04/2018 08:33:58 AM Eastern Daylight Time			08/04/2018 09:18:31 AM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Medicare (HMO)	01	01		1			H0724	003	0	2019	Delaware, Fairfield, Franklin Counties		2		2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	004	0	1	01	01	H0724_004_0	5	1				08/02/2018	2019.01	08/02/2018 08:23:37 AM Eastern Daylight Time	08/04/2018 08:34:00 AM Eastern Daylight Time	08/04/2018 08:34:00 AM Eastern Daylight Time			08/04/2018 09:18:31 AM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Medicare (HMO)	01	01		1			H0724	004	0	2019	Fulton, Lucas, Ottawa, Wood Counties		2		2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	801	0	1	01	01	H0724_801_0	1	1				05/29/2018	2019.01	05/29/2018 05:27:15 PM Pacific Daylight Time					06/03/2018 12:56:19 PM Pacific Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0724	801	0	2019	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0724	802	0	1	01	01	H0724_802_0	1	1				05/29/2018	2019.01	05/29/2018 04:03:46 PM Pacific Daylight Time					06/03/2018 12:56:19 PM Pacific Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0724	802	0	2019	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0724	803	0	1	01	01	H0724_803_0	1	1				05/29/2018	2019.01	05/29/2018 04:03:54 PM Pacific Daylight Time					06/03/2018 12:56:19 PM Pacific Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0724	803	0	2019	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0755	030	0	1	01	01	H0755_030_0	4	1				07/12/2018	2019.01	07/12/2018 11:49:03 AM Central Daylight Time	08/03/2018 09:44:35 AM Central Daylight Time	07/31/2018 05:49:16 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 1 (HMO)	01	01		1			H0755	030	0	2019	State of Connecticut		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	031	0	1	01	01	H0755_031_0	4	1				07/12/2018	2019.01	07/12/2018 11:50:11 AM Central Daylight Time	08/03/2018 09:45:06 AM Central Daylight Time	07/31/2018 05:49:38 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 2 (HMO)	01	01		1			H0755	031	0	2019	State of Connecticut		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	032	0	1	01	01	H0755_032_0	2	1				07/12/2018	2019.01	07/12/2018 11:52:14 AM Central Daylight Time	06/01/2018 04:43:03 PM Central Daylight Time				07/12/2018 05:47:25 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Essential (HMO)	01	01		1			H0755	032	0	2019	State of Connecticut		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0755	033	0	1	01	01	H0755_033_0	4	1				08/02/2018	2019.01	08/02/2018 01:46:12 PM Central Daylight Time	08/03/2018 09:46:09 AM Central Daylight Time	07/31/2018 05:50:02 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 3 (HMO)	01	01		1			H0755	033	0	2019	State of Connecticut		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	034	0	1	01	01	H0755_034_0	3	1				08/02/2018	2019.01	08/02/2018 01:54:37 PM Central Daylight Time	08/03/2018 09:46:40 AM Central Daylight Time	07/31/2018 05:50:26 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0755	034	0	2019	Select counties in New Jersey		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	035	0	1	01	01	H0755_035_0	3	1				07/12/2018	2019.01	07/12/2018 12:34:59 PM Central Daylight Time	08/03/2018 09:47:11 AM Central Daylight Time	07/31/2018 05:50:48 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H0755	035	0	2019	Select counties in New Jersey		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	036	0	1	01	01	H0755_036_0	3	1				07/12/2018	2019.01	07/12/2018 12:35:37 PM Central Daylight Time	08/03/2018 09:47:41 AM Central Daylight Time	07/31/2018 05:51:12 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 4 (HMO)	01	01		1			H0755	036	0	2019	Select counties in New Jersey		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	037	0	1	01	01	H0755_037_0	3	1				07/24/2018	2019.01	07/24/2018 08:52:07 AM Central Daylight Time	07/23/2018 12:08:37 PM Central Daylight Time				07/24/2018 01:08:51 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H0755	037	0	2019	Select counties in New Jersey		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0755	038	0	1	01	01	H0755_038_0	3	1				08/02/2018	2019.01	08/02/2018 01:57:10 PM Central Daylight Time	08/03/2018 09:48:31 AM Central Daylight Time	07/31/2018 05:51:38 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0755	038	0	2019	Essex and Ocean Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	810	0	1	01	01	H0755_810_0	1	1				05/25/2018	2019.01	05/25/2018 02:44:22 PM Central Daylight Time					06/02/2018 12:02:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	810	0	2019	Connecticut		1	3672	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0755	811	0	1	01	01	H0755_811_0	1	1				05/25/2018	2019.01	05/25/2018 02:44:37 PM Central Daylight Time					06/02/2018 12:02:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	811	0	2019	Connecticut		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H0755	812	0	1	01	01	H0755_812_0	1	1				05/25/2018	2019.01	05/25/2018 02:44:49 PM Central Daylight Time					06/02/2018 12:02:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	812	0	2019	Connecticut		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0755	813	0	1	01	01	H0755_813_0	1	1				05/25/2018	2019.01	05/25/2018 02:45:00 PM Central Daylight Time					06/02/2018 12:02:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	813	0	2019	NJ		1	3432	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0755	814	0	1	01	01	H0755_814_0	1	1				05/25/2018	2019.01	05/25/2018 02:46:01 PM Central Daylight Time					06/02/2018 12:02:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	814	0	2019	NJ		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H0755	815	0	1	01	01	H0755_815_0	1	1				05/25/2018	2019.01	05/25/2018 02:46:14 PM Central Daylight Time					06/02/2018 12:02:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	815	0	2019	NJ		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0809	001	0	1	20	08	H0809_001_0	1	1				06/01/2018	2019.01	06/01/2018 10:17:54 AM Eastern Daylight Time		05/31/2018 08:54:31 AM Eastern Daylight Time			06/01/2018 10:19:26 AM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	001	0	2019	Mercy LIFE		2		2			2						www.mercycares.com	www.mercycares.com										(413)748-7223		(413)748-7223		(413)748-7223		(413)748-7223										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370																
H0809	002	0	1	20	08	H0809_002_0	1	1				06/01/2018	2019.01	06/01/2018 10:18:18 AM Eastern Daylight Time		05/31/2018 08:54:23 AM Eastern Daylight Time			06/01/2018 10:19:26 AM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	002	0	2019	Mercy LIFE		2		2			2						www.mercycares.com	www.mercycares.com										(413)748-7223		(413)748-7223		(413)748-7223		(413)748-7223										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370																
H0819	001	0	1	20	08	H0819_001_0	1	1				05/25/2018	2019.01	05/25/2018 10:02:09 AM Eastern Daylight Time		05/25/2018 09:43:47 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE YORK, INC.	York County PACE	www.seniorlifepa.com	Senior LIFE York Dual Eligibile (PACE)	08	20		1			H0819	001	0	2019	Senior LIFE York County		2		2			2						http://granerx.com/	www.seniorlifeyork.com										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0819	002	0	1	20	08	H0819_002_0	1	1				05/25/2018	2019.01	05/25/2018 10:02:22 AM Eastern Daylight Time		05/25/2018 09:43:46 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE YORK, INC.	York County PACE	http://www.seniorlifeyork.com	Senior LIFE York Medicare Only (PACE)	08	20		1			H0819	002	0	2019	York County PACE Medicare Only		2		2			2						http://granerx.com/	www.seniorlifeyork.com										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0838	020	0	1	01	01	H0838_020_0	8	1		1		08/01/2018	2019.01	08/01/2018 09:00:08 AM Pacific Daylight Time	08/01/2018 02:29:49 PM Pacific Daylight Time	07/31/2018 01:18:02 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Harmony Choice Plan (HMO SNP)	01	01		1			H0838	020	0	2019	FRE IMP KER KIN LA ORA RIV SBD SCL SD SM TUL		2	37674	2			1	4			00000000000010000000		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	024	0	1	01	01	H0838_024_0	8	1	2	1		08/01/2018	2019.01	08/01/2018 08:58:58 AM Pacific Daylight Time	08/01/2018 02:30:43 PM Pacific Daylight Time	07/31/2018 01:19:31 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Dual Access Plan (HMO SNP)	01	01		1			H0838	024	0	2019	FRE IMP KER KIN LA ORA RIV SBD TUL		2	16332	2			1	3		2		2	www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	025	0	1	01	01	H0838_025_0	8	1				08/01/2018	2019.01	08/01/2018 08:56:30 AM Pacific Daylight Time	08/01/2018 02:31:36 PM Pacific Daylight Time	07/31/2018 01:19:25 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Classic Care I Plan (HMO)	01	01		1			H0838	025	0	2019	Counties:  KER LA ORA RIV SBD SD		2	66456	2			2						www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	028	0	1	01	01	H0838_028_0	8	1		1		08/01/2018	2019.01	08/01/2018 08:56:41 AM Pacific Daylight Time	08/01/2018 02:33:12 PM Pacific Daylight Time	07/31/2018 01:20:12 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Bridges Care Plan (HMO SNP)	01	01		1			H0838	028	0	2019	FRE IMP KER KIN LA ORA RIV SBD SD  SM SCL TUL		2	6456	2			1	4			00000100000000000000		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	029	0	1	01	01	H0838_029_0	9	1		1		08/01/2018	2019.01	08/01/2018 09:09:45 AM Pacific Daylight Time	08/01/2018 02:34:05 PM Pacific Daylight Time	07/31/2018 01:20:37 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Bridges Choice Medi-Medi Plan (HMO SNP)	01	01		1			H0838	029	0	2019	FRE IMP KER KIN  LA ORA RIV SBD SCL SD SM  TUL		2	5706	2			1	4			00000100000000000000		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	032	0	1	01	01	H0838_032_0	8	1		1		08/01/2018	2019.01	08/01/2018 09:00:18 AM Pacific Daylight Time	08/01/2018 02:35:15 PM Pacific Daylight Time	07/31/2018 01:20:54 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Harmony Care Plan (HMO SNP)	01	01		1			H0838	032	0	2019	FRE IMP KIN KER  LA ORA RIV SBD SCL SD SM TUL		2	4656	2			1	4			00000000000010000000		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	033	0	1	01	01	H0838_033_0	8	1				08/01/2018	2019.01	08/01/2018 08:59:13 AM Pacific Daylight Time	08/01/2018 02:36:07 PM Pacific Daylight Time	07/31/2018 01:21:35 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Classic Choice Medi-Medi Plan (HMO)	01	01		1			H0838	033	0	2019	FRE IMP KER KIN LA ORA RIV SBD SD SM SCL TUL		2	93564	2			2						www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	037	0	1	01	01	H0838_037_0	9	1				08/01/2018	2019.01	08/01/2018 08:57:23 AM Pacific Daylight Time	08/01/2018 02:37:51 PM Pacific Daylight Time	07/31/2018 01:21:46 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Classic Care II Plan (HMO)	01	01		1			H0838	037	0	2019	FRE IMP KER KIN LA ORA RIV SBD SCL SD SM TUL		2	70428	2			2						www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	039	1	1	01	01	H0838_039_1	7	1		1		08/01/2018	2019.01	08/01/2018 08:57:47 AM Pacific Daylight Time	08/01/2018 02:38:43 PM Pacific Daylight Time	07/31/2018 01:22:41 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Care Plan (HMO SNP)	01	01		1			H0838	039	1	2019	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM  TUL	KER LA ORA RIV SBD SD	2	34842	2			1	4			00000000000000000010		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	039	2	1	01	01	H0838_039_2	8	1		1		08/01/2018	2019.01	08/01/2018 08:57:58 AM Pacific Daylight Time	08/01/2018 02:39:35 PM Pacific Daylight Time	07/31/2018 01:23:58 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Care Plan (HMO SNP)	01	01		1			H0838	039	2	2019	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM  TUL	FRE IMP KIN SM SCL TUL	2	31992	2			1	4			00000000000000000010		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	040	1	1	01	01	H0838_040_1	8	1		1		08/01/2018	2019.01	08/01/2018 08:59:26 AM Pacific Daylight Time	08/01/2018 02:40:30 PM Pacific Daylight Time	07/31/2018 01:23:11 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Choice Medi-Medi Plan (HMO SNP)	01	01		1			H0838	040	1	2019	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM TUL	KER LA ORA RIV SBD SD	2	28872	2			1	4			00000000000000000010		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	040	2	1	01	01	H0838_040_2	7	1		1		08/01/2018	2019.01	08/01/2018 08:59:40 AM Pacific Daylight Time	08/01/2018 02:41:26 PM Pacific Daylight Time	07/31/2018 01:24:57 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Choice Medi-Medi Plan (HMO SNP)	01	01		1			H0838	040	2	2019	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM TUL	FRE IMP KIN SM SCL TUL	2	20664	2			1	4			00000000000000000010		www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	041	0	1	01	01	H0838_041_0	8	1		1		08/01/2018	2019.01	08/01/2018 03:13:06 PM Pacific Daylight Time	08/01/2018 03:09:20 PM Pacific Daylight Time	07/31/2018 01:24:32 PM Pacific Daylight Time			08/07/2018 11:59:01 AM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Select Care Plan (HMO SNP)	01	01		1			H0838	041	0	2019	FRE IMP KER KIN LA ORA RIV SBD SCL SD SM TUL		2	7920	2			1	1	1				www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0839	001	0	1	20	08	H0839_001_0	1	1				05/25/2018	2019.01	05/25/2018 12:18:54 PM Eastern Daylight Time		05/25/2018 12:11:55 PM Eastern Daylight Time			05/25/2018 12:20:51 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	Senior CommUnity Care of North Carolina	www.seniorcommunitycarenc.org	Senior CommUnity Care of North Carolina (PACE)	08	20		1			H0839	001	0	2019	Wake Co, Durham Co, Granville Co.		2		2			2						www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000																
H0839	002	0	1	20	08	H0839_002_0	1	1				05/25/2018	2019.01	05/25/2018 12:18:58 PM Eastern Daylight Time		05/25/2018 12:12:01 PM Eastern Daylight Time			05/25/2018 12:20:51 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	Senior CommUnity Care of North Carolina	www.seniorcommunitycarenc.org	Senior CommUnity Care of North Carolina (PACE)	08	20		1			H0839	002	0	2019	Wake Co., Durham Co, Granville Co		2		2			2						www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000																
H0908	001	0	1	01	01	H0908_001_0	6	1	2	1		08/02/2018	2019.01	08/02/2018 08:27:13 AM Eastern Daylight Time	08/04/2018 08:36:31 AM Eastern Daylight Time	08/04/2018 08:36:32 AM Eastern Daylight Time			08/04/2018 09:24:41 AM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Allwell	allwell.buckeyehealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H0908	001	0	2019	Statewide		2		2			1	3		2		2	advantage.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	advantage.buckeyehealthplan.com/findadoctor	(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	801	0	1	01	01	H0908_801_0	1	1				05/30/2018	2019.01	05/30/2018 11:49:40 AM Pacific Daylight Time					06/03/2018 03:22:41 PM Pacific Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	801	0	2019	Countywide		1	292	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0908	802	0	1	01	01	H0908_802_0	1	1				05/30/2018	2019.01	05/30/2018 11:49:57 AM Pacific Daylight Time					06/03/2018 03:22:41 PM Pacific Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	802	0	2019	Countywide		1	292	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0908	803	0	1	01	01	H0908_803_0	1	1				05/30/2018	2019.01	05/30/2018 11:50:27 AM Pacific Daylight Time					06/03/2018 03:22:41 PM Pacific Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	803	0	2019	Countywide		1	292	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0913	002	0	1	02	01	H0913_002_0	4	1				08/03/2018	2019.01	08/03/2018 03:01:50 PM Eastern Daylight Time	08/06/2018 04:11:25 PM Eastern Daylight Time	08/01/2018 02:01:26 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H0913	002	0	2019	Select counties in NJ		2	46640	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8570		(866)687-8570		(866)527-0056		(866)527-0056		(866)687-8570		(866)687-8570		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	013	0	1	01	01	H0913_013_0	4	1	2	1		08/03/2018	2019.01	08/03/2018 03:01:11 PM Eastern Daylight Time	08/06/2018 04:12:10 PM Eastern Daylight Time	08/01/2018 02:01:48 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H0913	013	0	2019	Select Counties in NJ		2	53783	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)706-9509		(877)706-9509		(866)527-0056		(866)527-0056		(877)706-9509		(877)706-9509		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	015	0	1	01	01	H0913_015_0	4	1				06/01/2018	2019.01	06/01/2018 04:54:52 PM Eastern Daylight Time	08/06/2018 04:12:54 PM Eastern Daylight Time	08/01/2018 02:02:08 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H0913	015	0	2019	Select Counties in NJ		2	3162	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8570		(866)687-8570		(866)527-0056		(866)527-0056		(866)687-8570		(866)687-8570		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0927	001	0	1	48	05	H0927_001_0	7	1				08/24/2018	2019.01	08/24/2018 10:41:14 AM Central Daylight Time					08/24/2018 12:31:10 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Community MMAI	www.hcsc.com	Blue Medicare Advantage (Medicare-Medicaid Plan)	05	48		1			H0927	001	0	2019	Cook, DuPage, Kane, Kankakee, Lake, and Will ctys		2	180000	2			2						www.yourpartd.com	https://myprime.com		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0982	001	0	1	01	01	H0982_001_0	10	1				07/19/2018	2019.01	07/19/2018 05:24:24 PM Eastern Daylight Time	08/03/2018 12:40:43 PM Eastern Daylight Time	08/01/2018 12:50:14 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO)	01	01		1			H0982	001	0	2019	Miami-Dade MAPD		2		2			2						www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b1;8b3;	
H0982	002	0	1	01	01	H0982_002_0	10	1	2	1		07/19/2018	2019.01	07/19/2018 05:24:52 PM Eastern Daylight Time	08/03/2018 12:28:01 PM Eastern Daylight Time	08/01/2018 12:52:13 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO SNP)	01	01		1			H0982	002	0	2019	Miami-Dade D-SNP		2		2			1	3		2		1	www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b1;8b3;	
H0982	005	0	1	01	01	H0982_005_0	9	1				06/29/2018	2019.01	06/29/2018 07:43:18 AM Central Daylight Time	08/03/2018 12:39:15 PM Eastern Daylight Time	08/01/2018 12:53:39 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO)	01	01		1			H0982	005	0	2019	Orange MAPD		2		2			2						www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	006	0	1	01	01	H0982_006_0	9	1	2	1		06/29/2018	2019.01	06/29/2018 07:40:24 AM Central Daylight Time	08/03/2018 12:37:56 PM Eastern Daylight Time	08/01/2018 12:54:59 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO SNP)	01	01		1			H0982	006	0	2019	Orange D-SNP		2		2			1	3		2		1	www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	007	0	1	01	01	H0982_007_0	9	1				06/29/2018	2019.01	06/29/2018 07:43:34 AM Central Daylight Time	08/03/2018 12:36:36 PM Eastern Daylight Time	08/01/2018 12:56:05 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO)	01	01		1			H0982	007	0	2019	Broward MAPD		2		2			2						www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	008	0	1	01	01	H0982_008_0	9	1				06/29/2018	2019.01	06/29/2018 07:43:45 AM Central Daylight Time	08/03/2018 12:35:21 PM Eastern Daylight Time	08/01/2018 12:57:10 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO)	01	01		1			H0982	008	0	2019	Palm Beach MAPD		2		2			2						www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	009	0	1	01	01	H0982_009_0	9	1				06/29/2018	2019.01	06/29/2018 07:43:59 AM Central Daylight Time	08/03/2018 12:33:29 PM Eastern Daylight Time	08/01/2018 12:58:36 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO)	01	01		1			H0982	009	0	2019	Hillsborough MAPD		2		2			2						www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	010	0	1	01	01	H0982_010_0	9	1	2	1		06/29/2018	2019.01	06/29/2018 07:41:32 AM Central Daylight Time	08/03/2018 12:30:05 PM Eastern Daylight Time	08/01/2018 01:00:52 PM Eastern Daylight Time			08/03/2018 02:31:41 PM Eastern Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	www.solishealthplans.com	Solis Health Plans (HMO SNP)	01	01		1			H0982	010	0	2019	Hillsborough D-SNP		2		2			1	3		2		1	www.solishealthplans.com/find-a-provider	www.solishealthplans.com	www.solishealthplans.com/find-a-provider	(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(844)447-6547		(305)913-0042		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	001	0	1	01	01	H1016_001_0	9	1				07/27/2018	2019.01	07/27/2018 05:13:24 PM Eastern Daylight Time	08/06/2018 04:26:47 PM Eastern Daylight Time	08/06/2018 04:26:48 PM Eastern Daylight Time			08/06/2018 04:38:29 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	001	0	2019	Miami-Dade County		2	13500	2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;	
H1016	021	0	1	01	01	H1016_021_0	9	1				07/27/2018	2019.01	07/27/2018 05:13:31 PM Eastern Daylight Time	08/06/2018 04:26:47 PM Eastern Daylight Time	08/06/2018 04:26:48 PM Eastern Daylight Time			08/06/2018 04:38:29 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	021	0	2019	Broward County		2	16000	2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;	
H1016	023	0	1	01	01	H1016_023_0	13	1				07/27/2018	2019.01	07/27/2018 05:13:36 PM Eastern Daylight Time	08/06/2018 04:27:01 PM Eastern Daylight Time	08/06/2018 04:27:02 PM Eastern Daylight Time			08/06/2018 04:38:29 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	023	0	2019	Miami-Dade County		2		2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	024	0	1	01	01	H1016_024_0	13	1				07/27/2018	2019.01	07/27/2018 05:13:41 PM Eastern Daylight Time	08/06/2018 04:27:02 PM Eastern Daylight Time	08/06/2018 04:27:02 PM Eastern Daylight Time			08/06/2018 04:38:29 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	024	0	2019	Broward County		2		2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	801	0	1	01	01	H1016_801_0	7	1				05/25/2018	2019.01	05/25/2018 06:53:17 AM Eastern Daylight Time					06/04/2018 03:28:37 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Plan (HMO)	01	01		1			H1016	801	0	2019	AvMed Florida Employer Group Plan		1	10	2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	802	0	1	01	01	H1016_802_0	7	1				05/25/2018	2019.01	05/25/2018 07:00:15 AM Eastern Daylight Time					06/04/2018 03:28:37 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Plan (HMO)	01	01		1			H1016	802	0	2019	AvMed Florida Employer Group Plan		1	10	2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1016	803	0	1	01	01	H1016_803_0	7	1				05/25/2018	2019.01	05/25/2018 07:07:46 AM Eastern Daylight Time					06/04/2018 03:28:37 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Non-CY Plan (HMO)	01	01		1			H1016	803	0	2019	AvMed Florida  Employer Group Plan		1	10	2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	804	0	1	01	01	H1016_804_0	7	1				05/25/2018	2019.01	05/25/2018 07:02:45 AM Eastern Daylight Time					06/04/2018 03:28:37 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Non-CY Plan (HMO)	01	01		1			H1016	804	0	2019	AvMed Florida Employer Group Plan		1	10	2			2						www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1019	001	0	1	01	01	H1019_001_0	5	1				07/02/2018	2019.01	07/02/2018 01:40:09 PM Eastern Daylight Time	08/03/2018 11:19:59 AM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	001	0	2019	Broward County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	006	0	1	01	01	H1019_006_0	3	1				06/01/2018	2019.01	06/01/2018 03:27:52 PM Eastern Daylight Time	07/16/2018 04:21:23 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	006	0	2019	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	023	0	1	01	01	H1019_023_0	5	1	2	1		07/20/2018	2019.01	07/20/2018 11:19:31 AM Eastern Daylight Time	07/20/2018 12:00:18 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	023	0	2019	Broward and Palm Beach counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	024	0	1	01	01	H1019_024_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 11:19:45 AM Eastern Daylight Time	07/20/2018 12:00:52 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	024	0	2019	Miami-Dade County		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	026	0	1	01	01	H1019_026_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:14:51 PM Eastern Daylight Time	07/16/2018 04:18:11 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	026	0	2019	Hillsborough, Pasco, Pinellas and Polk counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	028	0	1	01	01	H1019_028_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 12:55:32 PM Eastern Daylight Time	07/16/2018 04:19:16 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:08:12 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	028	0	2019	Select local counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	043	0	1	01	01	H1019_043_0	4	1				07/02/2018	2019.01	07/02/2018 01:40:37 PM Eastern Daylight Time	07/16/2018 04:12:13 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	043	0	2019	Brevard and Indian River counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	054	0	1	01	01	H1019_054_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:06 PM Eastern Daylight Time	07/16/2018 04:12:49 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	054	0	2019	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	057	0	1	01	01	H1019_057_0	4	1				07/02/2018	2019.01	07/02/2018 01:40:31 PM Eastern Daylight Time	07/16/2018 04:13:21 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:08:12 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	057	0	2019	Select local counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	060	0	1	01	01	H1019_060_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:18 PM Eastern Daylight Time	07/16/2018 04:14:02 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:02:27 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	060	0	2019	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	065	0	1	01	01	H1019_065_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:34 PM Eastern Daylight Time	07/16/2018 04:14:31 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	065	0	2019	Broward and Palm Beach counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	069	0	1	01	01	H1019_069_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:52 PM Eastern Daylight Time	07/16/2018 04:15:03 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	069	0	2019	Duval County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	073	0	1	01	01	H1019_073_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:00:04 PM Eastern Daylight Time	07/16/2018 04:20:17 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:08:12 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	073	0	2019	Duval County		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	076	0	1	01	01	H1019_076_0	4	1				07/02/2018	2019.01	07/02/2018 01:42:06 PM Eastern Daylight Time	07/16/2018 04:15:39 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree PLUS (HMO)	01	01		1			H1019	076	0	2019	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	077	0	1	01	01	H1019_077_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:02:31 PM Eastern Daylight Time	07/16/2018 04:19:48 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:08:12 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	077	0	2019	Select local counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	079	0	1	01	01	H1019_079_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:15:56 PM Eastern Daylight Time	07/16/2018 04:18:40 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	079	0	2019	Hillsborough, Pasco, Pinellas and Polk counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	081	0	1	01	01	H1019_081_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:16:48 PM Eastern Daylight Time	07/16/2018 04:16:43 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	081	0	2019	Broward and Palm Beach counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	083	0	1	01	01	H1019_083_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:17:37 PM Eastern Daylight Time	07/16/2018 04:17:41 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	083	0	2019	Miami-Dade County		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	085	0	1	01	01	H1019_085_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:03:39 PM Eastern Daylight Time	07/16/2018 04:20:50 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:08:12 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	085	0	2019	Duval County		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	089	0	1	01	01	H1019_089_0	4	1				06/04/2018	2019.01	06/04/2018 03:10:16 PM Eastern Daylight Time	07/16/2018 04:21:56 PM Eastern Daylight Time	08/03/2018 09:20:58 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareExtra (HMO)	01	01		1			H1019	089	0	2019	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	090	0	1	01	01	H1019_090_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:18:34 PM Eastern Daylight Time	07/16/2018 04:22:26 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	090	0	2019	Brevard and Indian River counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	091	0	1	01	01	H1019_091_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:20:19 PM Eastern Daylight Time	07/17/2018 10:08:52 AM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	091	0	2019	Brevard and Indian River counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	092	0	1	01	01	H1019_092_0	4	1				07/02/2018	2019.01	07/02/2018 01:40:50 PM Eastern Daylight Time	07/16/2018 04:23:27 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:08:12 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	092	0	2019	Select Local Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	094	0	1	01	01	H1019_094_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:09 PM Eastern Daylight Time	07/16/2018 04:24:00 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:08:12 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	094	0	2019	Duval County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	097	0	1	01	01	H1019_097_0	4	1				07/02/2018	2019.01	07/02/2018 01:42:30 PM Eastern Daylight Time	08/03/2018 11:19:25 AM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareExtra (HMO)	01	01		1			H1019	097	0	2019	Broward and Palm Beach counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2018-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	032	0	1	01	01	H1032_032_0	4	1				08/03/2018	2019.01	08/03/2018 03:49:07 PM Eastern Daylight Time	08/06/2018 04:13:38 PM Eastern Daylight Time	08/01/2018 02:02:29 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	032	0	2019	Select Counties in FL		2	26052	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	040	0	1	01	01	H1032_040_0	4	1				08/03/2018	2019.01	08/03/2018 03:48:26 PM Eastern Daylight Time	08/06/2018 04:14:22 PM Eastern Daylight Time	08/01/2018 02:02:50 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	040	0	2019	Miami-Dade County		2	38828	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	061	0	1	01	01	H1032_061_0	4	1	2	1		07/09/2018	2019.01	07/09/2018 10:27:49 AM Eastern Daylight Time	08/06/2018 04:15:05 PM Eastern Daylight Time	08/01/2018 02:03:12 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Select (HMO SNP)	01	01		1			H1032	061	0	2019	Select Counties in FL		2	23134	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	073	0	1	01	01	H1032_073_0	4	1				08/03/2018	2019.01	08/03/2018 03:46:40 PM Eastern Daylight Time	08/06/2018 04:15:47 PM Eastern Daylight Time	08/01/2018 02:03:33 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1032	073	0	2019	Duval County		2	20645	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	079	0	1	02	01	H1032_079_0	4	1				08/03/2018	2019.01	08/03/2018 03:46:00 PM Eastern Daylight Time	08/06/2018 04:16:28 PM Eastern Daylight Time	08/01/2018 02:03:53 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1032	079	0	2019	Select Counties in FL		2	10039	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	091	0	1	02	01	H1032_091_0	4	1				08/03/2018	2019.01	08/03/2018 03:45:20 PM Eastern Daylight Time	08/06/2018 04:17:09 PM Eastern Daylight Time	08/01/2018 02:04:14 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H1032	091	0	2019	Select Counties in FL		2	112144	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	124	0	1	01	01	H1032_124_0	5	1	2	1		07/12/2018	2019.01	07/12/2018 11:22:18 PM Eastern Daylight Time	08/06/2018 04:17:53 PM Eastern Daylight Time	08/01/2018 02:04:35 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1032	124	0	2019	Select Counties in FL		2	191789	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	133	0	1	02	01	H1032_133_0	4	1				08/03/2018	2019.01	08/03/2018 03:44:34 PM Eastern Daylight Time	08/06/2018 04:18:34 PM Eastern Daylight Time	08/01/2018 02:04:55 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1032	133	0	2019	Select Counties in FL		2	7690	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	170	0	1	01	01	H1032_170_0	4	1	2	1		05/27/2018	2019.01	05/27/2018 12:56:08 PM Eastern Daylight Time	08/06/2018 04:19:17 PM Eastern Daylight Time	08/01/2018 02:05:16 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1032	170	0	2019	Miami-Dade County		2	4229	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	174	0	1	02	01	H1032_174_0	4	1				08/03/2018	2019.01	08/03/2018 03:43:44 PM Eastern Daylight Time	08/06/2018 04:20:00 PM Eastern Daylight Time	08/01/2018 02:05:36 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H1032	174	0	2019	Select Counties in FL		2	54728	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	175	0	1	01	01	H1032_175_0	5	1	2	1		07/12/2018	2019.01	07/12/2018 11:25:07 PM Eastern Daylight Time	08/06/2018 04:20:42 PM Eastern Daylight Time	08/01/2018 02:05:57 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H1032	175	0	2019	Select Counties in FL		2	200502	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	176	0	1	01	01	H1032_176_0	4	1	2	1		05/27/2018	2019.01	05/27/2018 09:43:55 AM Eastern Daylight Time	08/06/2018 04:21:25 PM Eastern Daylight Time	08/01/2018 02:06:18 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H1032	176	0	2019	Miami-Dade County		2	5453	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	182	0	1	01	01	H1032_182_0	4	1	2	1		05/29/2018	2019.01	05/29/2018 01:26:28 PM Eastern Daylight Time	08/06/2018 04:22:09 PM Eastern Daylight Time	08/01/2018 02:06:39 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Select (HMO SNP)	01	01		1			H1032	182	0	2019	Select Counties in FL		2	28095	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	184	0	1	01	01	H1032_184_0	5	1		1		08/03/2018	2019.01	08/03/2018 03:42:55 PM Eastern Daylight Time	08/06/2018 04:22:53 PM Eastern Daylight Time	08/01/2018 02:06:59 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO SNP)	01	01		1			H1032	184	0	2019	Select Counties in FL		2	2219	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	186	0	1	01	01	H1032_186_0	6	1		1		08/03/2018	2019.01	08/03/2018 03:42:03 PM Eastern Daylight Time	08/06/2018 04:23:38 PM Eastern Daylight Time	08/01/2018 02:07:20 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO SNP)	01	01		1			H1032	186	0	2019	Select Counties in FL		2	3164	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	187	1	1	01	01	H1032_187_1	4	1				08/03/2018	2019.01	08/03/2018 03:41:14 PM Eastern Daylight Time	08/06/2018 04:24:23 PM Eastern Daylight Time	08/01/2018 02:07:41 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	187	1	2019	Select Counties in FL	Select Counties in FL	2	13106	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	187	2	1	01	01	H1032_187_2	4	1				08/03/2018	2019.01	08/03/2018 03:40:28 PM Eastern Daylight Time	08/06/2018 04:25:06 PM Eastern Daylight Time	08/01/2018 02:08:02 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	187	2	2019	Select Counties in FL	Select Counties in FL	2	82875	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	188	1	1	01	01	H1032_188_1	4	1				08/03/2018	2019.01	08/03/2018 03:39:50 PM Eastern Daylight Time	08/06/2018 04:25:50 PM Eastern Daylight Time	08/01/2018 02:08:22 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	188	1	2019	Select Counties in FL	Select Counties in FL	2	17628	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	188	2	1	01	01	H1032_188_2	4	1				08/03/2018	2019.01	08/03/2018 03:39:12 PM Eastern Daylight Time	08/06/2018 04:26:33 PM Eastern Daylight Time	08/01/2018 02:08:44 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	188	2	2019	Select Counties in FL	Select Counties in FL	2	5273	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	189	0	1	01	01	H1032_189_0	6	1				08/03/2018	2019.01	08/03/2018 03:38:14 PM Eastern Daylight Time	08/06/2018 04:27:17 PM Eastern Daylight Time	08/01/2018 02:09:04 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	189	0	2019	Select Counties in FL		2	1622	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	190	0	1	01	01	H1032_190_0	5	1				08/03/2018	2019.01	08/03/2018 03:37:32 PM Eastern Daylight Time	08/06/2018 04:28:00 PM Eastern Daylight Time	08/01/2018 02:09:25 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	190	0	2019	Select Counties in FL		2	684	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	191	0	1	01	01	H1032_191_0	4	1				08/03/2018	2019.01	08/03/2018 03:36:58 PM Eastern Daylight Time	08/06/2018 04:28:43 PM Eastern Daylight Time	08/01/2018 02:09:46 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	191	0	2019	Select Counties in FL		2	4346	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	192	0	1	01	01	H1032_192_0	5	1				08/03/2018	2019.01	08/03/2018 03:36:18 PM Eastern Daylight Time	08/06/2018 04:29:24 PM Eastern Daylight Time	08/01/2018 02:10:07 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	192	0	2019	Select Counties in FL		2	7789	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	193	0	1	01	01	H1032_193_0	4	1				08/03/2018	2019.01	08/03/2018 03:35:31 PM Eastern Daylight Time	08/06/2018 04:30:06 PM Eastern Daylight Time	08/01/2018 02:10:28 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	193	0	2019	Select Counties in FL		2	27851	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	194	0	1	01	01	H1032_194_0	5	1				08/03/2018	2019.01	08/03/2018 03:34:53 PM Eastern Daylight Time	08/06/2018 04:30:48 PM Eastern Daylight Time	08/01/2018 02:10:49 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	194	0	2019	Select Counties in FL		2	9091	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	195	0	1	01	01	H1032_195_0	4	1				08/03/2018	2019.01	08/03/2018 03:33:58 PM Eastern Daylight Time	08/06/2018 04:31:31 PM Eastern Daylight Time	08/01/2018 02:11:11 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	195	0	2019	Select Counties in FL		2	3807	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	196	0	1	01	01	H1032_196_0	5	1				08/03/2018	2019.01	08/03/2018 03:33:14 PM Eastern Daylight Time	08/06/2018 04:32:12 PM Eastern Daylight Time	08/01/2018 02:11:32 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	196	0	2019	Select Counties in FL		2	1426	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	197	0	1	01	01	H1032_197_0	5	1	2	1		07/13/2018	2019.01	07/13/2018 07:49:50 AM Eastern Daylight Time	08/06/2018 04:32:56 PM Eastern Daylight Time	08/01/2018 02:11:52 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO SNP)	01	01		1			H1032	197	0	2019	Select Counties in FL		2	1344	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	198	0	1	01	01	H1032_198_0	5	1				08/03/2018	2019.01	08/03/2018 03:32:08 PM Eastern Daylight Time	08/06/2018 04:33:37 PM Eastern Daylight Time	08/01/2018 02:12:13 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	198	0	2019	Select Counties in FL		2	4319	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	199	0	1	01	01	H1032_199_0	5	1				08/03/2018	2019.01	08/03/2018 03:31:31 PM Eastern Daylight Time	08/06/2018 04:34:21 PM Eastern Daylight Time	08/01/2018 02:12:34 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	199	0	2019	Select Counties in FL		2	6408	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	200	0	1	01	01	H1032_200_0	4	1				08/03/2018	2019.01	08/03/2018 03:30:46 PM Eastern Daylight Time	08/06/2018 04:35:02 PM Eastern Daylight Time	08/01/2018 02:12:55 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	200	0	2019	Select Counties in FL		2	55428	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	201	0	1	01	01	H1032_201_0	5	1				08/03/2018	2019.01	08/03/2018 03:29:56 PM Eastern Daylight Time	08/06/2018 04:35:44 PM Eastern Daylight Time	08/01/2018 02:13:15 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	201	0	2019	Select Counties in FL		2	57297	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	202	0	1	01	01	H1032_202_0	5	1	2	1		07/13/2018	2019.01	07/13/2018 07:55:10 AM Eastern Daylight Time	08/06/2018 04:36:27 PM Eastern Daylight Time	08/01/2018 02:13:36 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO SNP)	01	01		1			H1032	202	0	2019	Select Counties in FL		2	6268	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	203	0	1	01	01	H1032_203_0	5	1		1		08/03/2018	2019.01	08/03/2018 03:29:12 PM Eastern Daylight Time	08/06/2018 04:37:09 PM Eastern Daylight Time	08/01/2018 02:13:57 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Champion (HMO SNP)	01	01		1			H1032	203	0	2019	Select Counties in FL		2	1451	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	204	0	1	01	01	H1032_204_0	4	1				08/03/2018	2019.01	08/03/2018 03:28:30 PM Eastern Daylight Time	08/06/2018 04:37:52 PM Eastern Daylight Time	08/01/2018 02:14:17 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	204	0	2019	Select Counties in FL		2	6955	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	205	0	1	01	01	H1032_205_0	5	1				08/03/2018	2019.01	08/03/2018 03:27:51 PM Eastern Daylight Time	08/06/2018 04:38:34 PM Eastern Daylight Time	08/01/2018 02:14:38 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	205	0	2019	Select Counties in FL		2	14034	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	206	0	1	01	01	H1032_206_0	5	1	2	1		07/13/2018	2019.01	07/13/2018 08:03:06 AM Eastern Daylight Time	08/06/2018 04:39:17 PM Eastern Daylight Time	08/01/2018 02:14:58 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO SNP)	01	01		1			H1032	206	0	2019	Select Counties in FL		2	1962	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	209	0	1	01	01	H1032_209_0	4	1				08/03/2018	2019.01	08/03/2018 03:27:19 PM Eastern Daylight Time	08/06/2018 04:40:00 PM Eastern Daylight Time	08/01/2018 02:15:20 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	209	0	2019	Select Counties in FL		2	4645	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	210	0	1	01	01	H1032_210_0	4	1				08/03/2018	2019.01	08/03/2018 03:26:01 PM Eastern Daylight Time	08/06/2018 04:40:44 PM Eastern Daylight Time	08/01/2018 02:15:41 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	210	0	2019	Select Counties in FL		2	7239	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	211	0	1	01	01	H1032_211_0	5	1				08/03/2018	2019.01	08/03/2018 03:25:21 PM Eastern Daylight Time	08/06/2018 04:41:25 PM Eastern Daylight Time	08/01/2018 02:16:02 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	211	0	2019	Select Counties in FL		2	13294	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	212	0	1	01	01	H1032_212_0	4	1				08/03/2018	2019.01	08/03/2018 03:52:00 PM Eastern Daylight Time	08/06/2018 04:42:08 PM Eastern Daylight Time	08/01/2018 02:16:23 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	212	0	2019	Select Counties in FL		2	62643	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	213	0	1	01	01	H1032_213_0	5	1				08/03/2018	2019.01	08/03/2018 03:51:25 PM Eastern Daylight Time	08/06/2018 04:42:50 PM Eastern Daylight Time	08/01/2018 02:16:44 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	213	0	2019	Select Counties in FL		2	64896	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	214	0	1	01	01	H1032_214_0	5	1	2	1		07/13/2018	2019.01	07/13/2018 08:17:41 AM Eastern Daylight Time	08/06/2018 04:43:32 PM Eastern Daylight Time	08/01/2018 02:17:06 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO SNP)	01	01		1			H1032	214	0	2019	Select Counties in FL		2	12353	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	215	0	1	01	01	H1032_215_0	4	1				08/03/2018	2019.01	08/03/2018 03:50:46 PM Eastern Daylight Time	08/06/2018 04:44:15 PM Eastern Daylight Time	08/01/2018 02:17:26 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	01	01		1			H1032	215	0	2019	Select Counties in FL		2	8310	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	216	0	1	01	01	H1032_216_0	5	1				08/03/2018	2019.01	08/03/2018 03:49:54 PM Eastern Daylight Time	08/06/2018 04:44:57 PM Eastern Daylight Time	08/01/2018 02:17:48 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	216	0	2019	Select Counties in FL		2	3247	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	217	0	1	01	01	H1032_217_0	5	1	2	1		07/13/2018	2019.01	07/13/2018 08:24:49 AM Eastern Daylight Time	08/06/2018 04:45:41 PM Eastern Daylight Time	08/01/2018 02:18:09 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO SNP)	01	01		1			H1032	217	0	2019	Select Counties in FL		2	1217	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	218	0	1	01	01	H1032_218_0	5	1				08/03/2018	2019.01	08/03/2018 03:24:33 PM Eastern Daylight Time	08/06/2018 04:46:24 PM Eastern Daylight Time	08/01/2018 02:18:29 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H1032	218	0	2019	Select Counties in FL		2	2416	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1035	002	0	1	02	01	H1035_002_0	8	1				08/06/2018	2019.01	08/06/2018 11:19:38 AM Eastern Daylight Time	08/06/2018 09:43:57 AM Eastern Daylight Time	08/06/2018 09:59:04 AM Eastern Daylight Time			08/06/2018 12:27:52 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Rx Plus (HMO-POS)	01	02		1			H1035	002	0	2019	Flagler and Volusia Counties, FL		2	98459	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	006	0	1	01	01	H1035_006_0	7	1				08/06/2018	2019.01	08/06/2018 11:03:09 AM Eastern Daylight Time	08/06/2018 09:42:25 AM Eastern Daylight Time	08/06/2018 09:58:07 AM Eastern Daylight Time			08/06/2018 12:27:52 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Rx (HMO)	01	01		1			H1035	006	0	2019	Flagler and Volusia Counties, FL		2	60245	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	011	0	1	01	01	H1035_011_0	7	1				08/06/2018	2019.01	08/06/2018 11:03:49 AM Eastern Daylight Time	08/06/2018 09:40:51 AM Eastern Daylight Time	08/06/2018 09:54:50 AM Eastern Daylight Time			08/06/2018 12:27:52 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Premier Plus (HMO)	01	01		1			H1035	011	0	2019	Brevard, Seminole and St. Johns Counties, FL		2	15777	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	014	0	1	01	01	H1035_014_0	7	1				08/06/2018	2019.01	08/06/2018 11:04:23 AM Eastern Daylight Time	08/06/2018 09:38:25 AM Eastern Daylight Time	08/06/2018 09:56:52 AM Eastern Daylight Time			08/06/2018 12:27:52 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Rx Savings (HMO)	01	01		1			H1035	014	0	2019	Volusia and Flagler Counties, FL		2	6000	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	016	0	1	01	01	H1035_016_0	7	1				08/06/2018	2019.01	08/06/2018 11:05:09 AM Eastern Daylight Time	08/06/2018 09:45:32 AM Eastern Daylight Time	08/06/2018 09:55:59 AM Eastern Daylight Time			08/06/2018 12:27:52 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Flagler Advantage (HMO)	01	01		1			H1035	016	0	2019	St. Johns County		2	6000	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	017	0	1	01	01	H1035_017_0	10	1				08/07/2018	2019.01	08/07/2018 09:25:23 AM Eastern Daylight Time	08/06/2018 12:54:53 PM Eastern Daylight Time	07/31/2018 06:53:33 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	017	0	2019	Miami-Dade County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	018	0	1	01	01	H1035_018_0	10	1				08/07/2018	2019.01	08/07/2018 09:26:15 AM Eastern Daylight Time	08/06/2018 12:58:06 PM Eastern Daylight Time	07/31/2018 06:55:42 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	018	0	2019	Palm Beach County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	019	0	1	01	01	H1035_019_0	10	1				08/07/2018	2019.01	08/07/2018 09:28:56 AM Eastern Daylight Time	08/06/2018 12:59:18 PM Eastern Daylight Time	07/31/2018 06:57:17 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	019	0	2019	South, Central and NE counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	020	0	1	01	01	H1035_020_0	10	1				08/07/2018	2019.01	08/07/2018 09:29:28 AM Eastern Daylight Time	08/06/2018 01:00:21 PM Eastern Daylight Time	07/31/2018 06:58:55 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	020	0	2019	Orange, Osceola & Seminole counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	021	0	1	01	01	H1035_021_0	10	1				08/07/2018	2019.01	08/07/2018 09:30:01 AM Eastern Daylight Time	08/06/2018 01:03:23 PM Eastern Daylight Time	07/31/2018 07:00:38 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	021	0	2019	Hillsborough, Hernando, Pasco and Polk counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	022	0	1	01	01	H1035_022_0	10	1				08/07/2018	2019.01	08/07/2018 09:30:54 AM Eastern Daylight Time	08/06/2018 01:05:20 PM Eastern Daylight Time	07/31/2018 07:12:22 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	01	01		1			H1035	022	0	2019	Palm Beach County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	023	0	1	01	01	H1035_023_0	9	1				08/07/2018	2019.01	08/07/2018 09:31:26 AM Eastern Daylight Time	08/06/2018 01:43:25 PM Eastern Daylight Time	07/31/2018 07:24:17 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	01	01		1			H1035	023	0	2019	Hillsborough and Polk counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	024	0	1	01	01	H1035_024_0	9	1				08/07/2018	2019.01	08/07/2018 09:32:04 AM Eastern Daylight Time	08/06/2018 01:44:35 PM Eastern Daylight Time	07/31/2018 07:25:51 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	024	0	2019	Miami-Dade County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	025	0	1	01	01	H1035_025_0	9	1				08/07/2018	2019.01	08/07/2018 09:33:25 AM Eastern Daylight Time	08/06/2018 01:45:41 PM Eastern Daylight Time	07/31/2018 07:27:38 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	025	0	2019	Broward County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	026	0	1	01	01	H1035_026_0	9	1				08/07/2018	2019.01	08/07/2018 09:34:26 AM Eastern Daylight Time	08/06/2018 01:48:16 PM Eastern Daylight Time	07/31/2018 07:29:09 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	026	0	2019	Orange County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	027	0	1	01	01	H1035_027_0	10	1	2	1		08/07/2018	2019.01	08/07/2018 09:34:59 AM Eastern Daylight Time	08/06/2018 01:49:58 PM Eastern Daylight Time	07/31/2018 07:30:43 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO SNP)	01	01		1			H1035	027	0	2019	Miami-Dade County		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	028	0	1	01	01	H1035_028_0	10	1	2	1		08/07/2018	2019.01	08/07/2018 09:35:29 AM Eastern Daylight Time	08/06/2018 01:52:06 PM Eastern Daylight Time	07/31/2018 07:32:30 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO SNP)	01	01		1			H1035	028	0	2019	Broward and Palm Beach counties		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	029	0	1	01	01	H1035_029_0	10	1	2	1		08/07/2018	2019.01	08/07/2018 09:36:37 AM Eastern Daylight Time	08/06/2018 01:54:22 PM Eastern Daylight Time	07/31/2018 07:34:01 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO SNP)	01	01		1			H1035	029	0	2019	Orange County		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	030	0	1	01	01	H1035_030_0	10	1	2	1		08/07/2018	2019.01	08/07/2018 09:37:37 AM Eastern Daylight Time	08/06/2018 01:59:07 PM Eastern Daylight Time	07/31/2018 07:35:35 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO SNP)	01	01		1			H1035	030	0	2019	Hillsborough and Polk counties		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1035	801	0	1	01	01	H1035_801_0	1	1				06/01/2018	2019.01	06/01/2018 04:25:17 PM Eastern Daylight Time					06/03/2018 01:31:53 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	www.FHCPMedicare.com	GRPMED (HMO)	01	01		1			H1035	801	0	2019	Florida		1	500	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;12;16b;	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;12;16b;	1					2				
H1035	802	0	1	01	01	H1035_802_0	1	1				06/01/2018	2019.01	06/01/2018 04:25:30 PM Eastern Daylight Time					06/03/2018 01:33:06 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Blue HMO	www.FHCPMedicare.com	GRPMED+ (HMO)	01	01		1			H1035	802	0	2019	Florida		1	500	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;12;16b;	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;12;16b;	1					2				
H1036	025	0	1	01	01	H1036_025_0	4	1				07/02/2018	2019.01	07/02/2018 01:39:15 PM Eastern Daylight Time	07/16/2018 04:38:17 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 11:06:51 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-025 (HMO)	01	01		1			H1036	025	0	2019	Hillsborough, Pasco and Pinellas counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	044	0	1	01	01	H1036_044_0	5	1				07/02/2018	2019.01	07/02/2018 01:38:06 PM Eastern Daylight Time	07/16/2018 04:48:43 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-044 (HMO)	01	01		1			H1036	044	0	2019	Flagler and Volusia counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	054	0	1	01	01	H1036_054_0	4	1				07/03/2018	2019.01	07/03/2018 08:46:32 AM Eastern Daylight Time	07/13/2018 05:44:59 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-054C (HMO)	01	01		1			H1036	054	0	2019	Miami-Dade County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	056	0	1	01	01	H1036_056_0	3	1				07/02/2018	2019.01	07/02/2018 01:38:16 PM Eastern Daylight Time	07/16/2018 03:51:00 PM Eastern Daylight Time				07/18/2018 04:31:21 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-056 (HMO)	01	01		1			H1036	056	0	2019	Flagler and Volusia counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	062	0	1	01	01	H1036_062_0	4	1				07/03/2018	2019.01	07/03/2018 08:50:37 AM Eastern Daylight Time	07/13/2018 05:50:03 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-062C (HMO)	01	01		1			H1036	062	0	2019	Palm Beach County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	065	0	1	01	01	H1036_065_0	5	1				07/03/2018	2019.01	07/03/2018 08:56:22 AM Eastern Daylight Time	07/13/2018 05:49:43 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-065C (HMO)	01	01		1			H1036	065	0	2019	Broward County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	067	0	1	01	01	H1036_067_0	4	1				07/02/2018	2019.01	07/02/2018 01:39:26 PM Eastern Daylight Time	07/16/2018 03:47:12 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-067 (HMO)	01	01		1			H1036	067	0	2019	Hernando County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	068	0	1	01	01	H1036_068_0	5	1				07/02/2018	2019.01	07/02/2018 01:38:25 PM Eastern Daylight Time	07/16/2018 03:52:17 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-068 (HMO)	01	01		1			H1036	068	0	2019	Jacksonville Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	074	0	1	01	01	H1036_074_0	4	1				07/02/2018	2019.01	07/02/2018 01:39:35 PM Eastern Daylight Time	07/16/2018 03:48:25 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-074 (HMO)	01	01		1			H1036	074	0	2019	Manatee County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	077	0	1	01	01	H1036_077_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 11:11:46 AM Eastern Daylight Time	08/03/2018 05:41:16 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-077A (HMO SNP)	01	01		1			H1036	077	0	2019	Miami-Dade County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	081	0	1	01	01	H1036_081_0	5	1				07/02/2018	2019.01	07/02/2018 01:38:34 PM Eastern Daylight Time	07/16/2018 04:47:23 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-081D (HMO)	01	01		1			H1036	081	0	2019	Baker, Duval and Nassau counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	102	0	1	01	01	H1036_102_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 11:18:31 AM Eastern Daylight Time	07/20/2018 01:37:28 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-102 (HMO SNP)	01	01		1			H1036	102	0	2019	Tampa Metro Area		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	103	0	1	01	01	H1036_103_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:09:08 PM Eastern Daylight Time	07/13/2018 05:47:00 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-103A (HMO SNP)	01	01		1			H1036	103	0	2019	Broward County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	104	0	1	01	01	H1036_104_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:15:49 PM Eastern Daylight Time	07/13/2018 05:48:22 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-104A (HMO SNP)	01	01		1			H1036	104	0	2019	Palm Beach County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	119	0	1	01	01	H1036_119_0	3	1				07/02/2018	2019.01	07/02/2018 01:39:45 PM Eastern Daylight Time	07/16/2018 03:49:41 PM Eastern Daylight Time				07/18/2018 04:27:30 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-119 (HMO)	01	01		1			H1036	119	0	2019	Tampa Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	121	0	1	01	01	H1036_121_0	4	1		1		07/03/2018	2019.01	07/03/2018 09:18:02 AM Eastern Daylight Time	07/13/2018 05:44:19 PM Eastern Daylight Time	08/03/2018 09:20:59 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	121	0	2019	Broward County		2		2			1	4			00000010000000000000		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	130	0	1	01	01	H1036_130_0	4	1		1		07/03/2018	2019.01	07/03/2018 09:23:44 AM Eastern Daylight Time	07/16/2018 10:51:00 AM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:01:14 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	130	0	2019	Palm Beach County		2		2			1	4			00000010000000000000		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	137	0	1	01	01	H1036_137_0	5	1				07/18/2018	2019.01	07/18/2018 05:23:23 PM Eastern Daylight Time	07/17/2018 10:15:12 AM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-137 (HMO)	01	01		1			H1036	137	0	2019	Charlotte Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	140	0	1	01	01	H1036_140_0	4	1				07/02/2018	2019.01	07/02/2018 01:49:13 PM Eastern Daylight Time	07/16/2018 03:53:37 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-140 (HMO)	01	01		1			H1036	140	0	2019	Citrus County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	143	0	1	01	01	H1036_143_0	5	1				07/02/2018	2019.01	07/02/2018 01:38:51 PM Eastern Daylight Time	07/16/2018 03:54:57 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-143 (HMO)	01	01		1			H1036	143	0	2019	Bay, Escambia, Santa Rosa and Walton counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	146	0	1	01	01	H1036_146_0	5	1				07/02/2018	2019.01	07/02/2018 01:39:01 PM Eastern Daylight Time	07/16/2018 03:56:20 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-146 (HMO)	01	01		1			H1036	146	0	2019	Orange, Osceola and Seminole counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	151	0	1	01	01	H1036_151_0	5	1				07/18/2018	2019.01	07/18/2018 05:17:59 PM Eastern Daylight Time	06/01/2018 03:14:09 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-151 (HMO)	01	01		1			H1036	151	0	2019	Jackson Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	153	0	1	01	01	H1036_153_0	4	1				07/02/2018	2019.01	07/02/2018 02:23:53 PM Eastern Daylight Time	06/01/2018 02:31:40 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:35:12 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-153 (HMO)	01	01		1			H1036	153	0	2019	Clackamas, Multnomah and Washington counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	156	0	1	01	01	H1036_156_0	5	1		1		07/02/2018	2019.01	07/02/2018 01:39:15 PM Eastern Daylight Time	07/16/2018 03:57:40 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	156	0	2019	Flagler and Volusia counties		2		2			1	4			00000010000000000000		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	157	0	1	01	01	H1036_157_0	5	1				07/02/2018	2019.01	07/02/2018 01:39:26 PM Eastern Daylight Time	07/16/2018 04:00:23 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-157 (HMO)	01	01		1			H1036	157	0	2019	Flagler and Volusia counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	160	0	1	01	01	H1036_160_0	4	1		1		07/02/2018	2019.01	07/02/2018 01:40:04 PM Eastern Daylight Time	07/16/2018 03:59:02 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	160	0	2019	Tampa Metro Area		2		2			1	4			00000010000000000000		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	167	0	1	01	01	H1036_167_0	5	1	2	1		07/16/2018	2019.01	07/16/2018 01:03:40 PM Eastern Daylight Time	07/17/2018 10:09:21 AM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-167 (HMO SNP)	01	01		1			H1036	167	0	2019	Charlotte Metro Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	168	0	1	01	01	H1036_168_0	5	1	2	1		07/16/2018	2019.01	07/16/2018 01:04:36 PM Eastern Daylight Time	08/03/2018 09:53:50 AM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-168 (HMO SNP)	01	01		1			H1036	168	0	2019	Greensboro / Winston-Salem Metro Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	171	0	1	01	01	H1036_171_0	5	1				07/18/2018	2019.01	07/18/2018 05:20:21 PM Eastern Daylight Time	06/01/2018 03:18:29 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-171 (HMO)	01	01		1			H1036	171	0	2019	Gulf Coast Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	175	0	1	01	01	H1036_175_0	5	1		1		07/02/2018	2019.01	07/02/2018 01:39:38 PM Eastern Daylight Time	07/16/2018 04:01:40 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	175	0	2019	Jacksonville Area		2		2			1	4			00000010000000000000		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	199	0	1	01	01	H1036_199_0	5	1				07/03/2018	2019.01	07/03/2018 09:25:52 AM Eastern Daylight Time	07/13/2018 05:45:39 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-199 (HMO)	01	01		1			H1036	199	0	2019	Palm Beach County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	209	0	1	01	01	H1036_209_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:28:44 PM Eastern Daylight Time	07/16/2018 04:16:31 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-209 (HMO SNP)	01	01		1			H1036	209	0	2019	Flagler and Volusia counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	210	0	1	01	01	H1036_210_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:31:42 PM Eastern Daylight Time	07/16/2018 04:19:28 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-210 (HMO SNP)	01	01		1			H1036	210	0	2019	Jacksonville Area		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	213	0	1	01	01	H1036_213_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:34:09 PM Eastern Daylight Time	07/16/2018 04:13:36 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-213 (HMO SNP)	01	01		1			H1036	213	0	2019	Greater Orlando		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	214	0	1	01	01	H1036_214_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:36:28 PM Eastern Daylight Time	08/03/2018 03:20:37 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-214 (HMO SNP)	01	01		1			H1036	214	0	2019	Bay, Escambia, Santa Rosa and Walton counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	215	0	1	01	01	H1036_215_0	4	1				07/02/2018	2019.01	07/02/2018 01:40:14 PM Eastern Daylight Time	07/16/2018 04:03:02 PM Eastern Daylight Time	08/03/2018 09:21:00 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-215 (HMO)	01	01		1			H1036	215	0	2019	Sarasota County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	217	0	1	01	01	H1036_217_0	4	1				07/02/2018	2019.01	07/02/2018 01:40:27 PM Eastern Daylight Time	07/16/2018 04:41:18 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-217 (HMO)	01	01		1			H1036	217	0	2019	Charlotte, Collier and Lee counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	219	0	1	01	01	H1036_219_0	4	1				07/02/2018	2019.01	07/02/2018 02:24:49 PM Eastern Daylight Time	06/01/2018 02:33:34 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:35:12 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-219 (HMO)	01	01		1			H1036	219	0	2019	Deschutes and Jefferson counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	222	0	1	01	01	H1036_222_0	5	1	2	1		07/16/2018	2019.01	07/16/2018 01:04:04 PM Eastern Daylight Time	07/16/2018 03:53:51 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-222 (HMO SNP)	01	01		1			H1036	222	0	2019	Select Counties in Mississippi		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	223	0	1	01	01	H1036_223_0	5	1				07/18/2018	2019.01	07/18/2018 05:21:00 PM Eastern Daylight Time	06/01/2018 03:18:58 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-223 (HMO)	01	01		1			H1036	223	0	2019	DeSoto County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	226	0	1	01	01	H1036_226_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 10:52:47 AM Eastern Daylight Time	07/13/2018 05:49:02 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-226 (HMO SNP)	01	01		1			H1036	226	0	2019	Glades, Martin, Okeechobee and St. Lucie counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	229	0	1	01	01	H1036_229_0	4	1				07/03/2018	2019.01	07/03/2018 09:29:34 AM Eastern Daylight Time	07/13/2018 05:45:59 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-229 (HMO)	01	01		1			H1036	229	0	2019	Glades, Martin, Okeechobee and St. Lucie counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	230	0	1	01	01	H1036_230_0	4	1				07/02/2018	2019.01	07/02/2018 01:40:38 PM Eastern Daylight Time	07/16/2018 04:04:20 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:49:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-230 (HMO)	01	01		1			H1036	230	0	2019	Hardee, Highlands and Polk counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	231	0	1	01	01	H1036_231_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:09:14 PM Eastern Daylight Time	07/16/2018 04:10:36 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-231 (HMO SNP)	01	01		1			H1036	231	0	2019	Hardee, Highlands and Polk counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	233	0	1	01	01	H1036_233_0	5	1				07/18/2018	2019.01	07/18/2018 05:25:07 PM Eastern Daylight Time	07/17/2018 10:15:44 AM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-233 (HMO)	01	01		1			H1036	233	0	2019	Raleigh Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	234	0	1	01	01	H1036_234_0	3	1		1		07/20/2018	2019.01	07/20/2018 11:05:00 AM Eastern Daylight Time	07/22/2018 09:50:07 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:32:54 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community HMO Diabetes and Heart (HMO SNP)	01	01		1			H1036	234	0	2019	Jefferson County		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	235	0	1	01	01	H1036_235_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 11:07:10 AM Eastern Daylight Time	08/03/2018 03:26:44 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:32:54 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community HMO SNP-DE (HMO SNP)	01	01		1			H1036	235	0	2019	Jefferson County		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	236	0	1	01	01	H1036_236_0	4	1				07/18/2018	2019.01	07/18/2018 05:43:08 PM Eastern Daylight Time	08/03/2018 03:25:39 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:32:54 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H1036	236	0	2019	Jefferson County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	237	1	1	01	01	H1036_237_1	4	1				07/02/2018	2019.01	07/02/2018 01:36:09 PM Eastern Daylight Time	07/13/2018 05:46:19 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	1	2019	South Florida: Broward or Miami-Dade	South Florida- Broward	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	237	2	1	01	01	H1036_237_2	4	1				07/02/2018	2019.01	07/02/2018 01:36:20 PM Eastern Daylight Time	07/13/2018 05:45:19 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	2	2019	South Florida: Broward or Miami-Dade	South Florida- Miami-Dade	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	241	0	1	01	01	H1036_241_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:38:58 PM Eastern Daylight Time	07/16/2018 04:15:03 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-241 (HMO SNP)	01	01		1			H1036	241	0	2019	Flagler and Volusia counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	243	0	1	01	01	H1036_243_0	4	1	2	1		05/29/2018	2019.01	05/29/2018 05:11:33 PM Eastern Daylight Time	07/16/2018 04:17:59 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-243 (HMO SNP)	01	01		1			H1036	243	0	2019	Jacksonville Area		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	245	0	1	01	01	H1036_245_0	5	1	2	1		07/02/2018	2019.01	07/02/2018 01:39:56 PM Eastern Daylight Time	08/03/2018 03:19:17 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-245 (HMO SNP)	01	01		1			H1036	245	0	2019	Bay, Escambia, Santa Rosa and Walton counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	247	0	1	01	01	H1036_247_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 03:30:22 PM Eastern Daylight Time	08/03/2018 03:17:59 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-247 (HMO SNP)	01	01		1			H1036	247	0	2019	Greater Orlando		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	249	0	1	01	01	H1036_249_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:23:33 PM Eastern Daylight Time	07/13/2018 05:48:42 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-249 (HMO SNP)	01	01		1			H1036	249	0	2019	Glades, Martin, Okeechobee and St. Lucie counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	251	0	1	01	01	H1036_251_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:18:04 PM Eastern Daylight Time	07/16/2018 04:05:45 PM Eastern Daylight Time	08/03/2018 09:21:01 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-251 (HMO SNP)	01	01		1			H1036	251	0	2019	Tampa Metro Area		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	253	0	1	01	01	H1036_253_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:22:57 PM Eastern Daylight Time	07/16/2018 04:09:03 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-253 (HMO SNP)	01	01		1			H1036	253	0	2019	Hardee, Highlands and Polk counties		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	255	0	1	01	01	H1036_255_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:26:36 PM Eastern Daylight Time	07/13/2018 05:46:40 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-255 (HMO SNP)	01	01		1			H1036	255	0	2019	Broward County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	257	0	1	01	01	H1036_257_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:30:11 PM Eastern Daylight Time	07/13/2018 05:47:21 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-257 (HMO SNP)	01	01		1			H1036	257	0	2019	Miami-Dade County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	259	0	1	01	01	H1036_259_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:33:05 PM Eastern Daylight Time	07/13/2018 05:48:01 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-259 (HMO SNP)	01	01		1			H1036	259	0	2019	Palm Beach County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	261	0	1	01	01	H1036_261_0	3	1	2	1		07/16/2018	2019.01	07/16/2018 01:25:29 PM Eastern Daylight Time	07/16/2018 04:24:25 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-261 (HMO SNP)	01	01		1			H1036	261	0	2019	Sarasota County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	262	0	1	01	01	H1036_262_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 06:42:14 PM Eastern Daylight Time	07/16/2018 04:25:59 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-262 (HMO SNP)	01	01		1			H1036	262	0	2019	Sarasota County		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	263	0	1	01	01	H1036_263_0	5	1				07/03/2018	2019.01	07/03/2018 10:58:18 AM Eastern Daylight Time	07/17/2018 10:21:26 AM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-263 (HMO)	01	01		1			H1036	263	0	2019	Charlotte Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	264	0	1	01	01	H1036_264_0	3	1				07/16/2018	2019.01	07/16/2018 01:36:25 PM Eastern Daylight Time	07/13/2018 05:49:23 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:12:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H1036-264 (HMO)	01	01		1			H1036	264	0	2019	Miami-Dade County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	265	1	1	01	01	H1036_265_1	4	1				07/02/2018	2019.01	07/02/2018 01:40:51 PM Eastern Daylight Time	07/16/2018 04:35:06 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-265 (HMO)	01	01		1			H1036	265	1	2019	Tampa Metro Area	Tampa Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	265	2	1	01	01	H1036_265_2	4	1				07/02/2018	2019.01	07/02/2018 01:41:01 PM Eastern Daylight Time	07/17/2018 10:12:50 AM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-265 (HMO)	01	01		1			H1036	265	2	2019	Tampa Metro Area	Manatee County	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	266	0	1	01	01	H1036_266_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:12 PM Eastern Daylight Time	07/16/2018 04:27:09 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-266 (HMO)	01	01		1			H1036	266	0	2019	Citrus County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	267	0	1	01	01	H1036_267_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:21 PM Eastern Daylight Time	07/16/2018 04:42:49 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-267 (HMO)	01	01		1			H1036	267	0	2019	Sarasota County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	268	0	1	01	01	H1036_268_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:31 PM Eastern Daylight Time	07/16/2018 04:32:02 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 11:02:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-268 (HMO)	01	01		1			H1036	268	0	2019	Hardee, Highlands and Polk counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	269	0	1	01	01	H1036_269_0	5	1				07/02/2018	2019.01	07/02/2018 01:40:05 PM Eastern Daylight Time	07/16/2018 04:33:29 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-269 (HMO)	01	01		1			H1036	269	0	2019	Greater Orlando		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	270	0	1	01	01	H1036_270_0	5	1				07/02/2018	2019.01	07/02/2018 01:40:17 PM Eastern Daylight Time	07/16/2018 04:39:53 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-270 (HMO)	01	01		1			H1036	270	0	2019	Jacksonville Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	271	0	1	01	01	H1036_271_0	5	1				07/02/2018	2019.01	07/02/2018 01:40:34 PM Eastern Daylight Time	07/16/2018 04:36:33 PM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-271 (HMO)	01	01		1			H1036	271	0	2019	Bay, Escambia, Santa Rosa and Walton counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	275	1	1	01	01	H1036_275_1	5	1				07/18/2018	2019.01	07/18/2018 05:26:02 PM Eastern Daylight Time	07/17/2018 10:32:41 AM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-275 (HMO)	01	01		1			H1036	275	1	2019	Greensboro - Winston Salem Metro Area	Greensboro - Winston Salem	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	275	2	1	01	01	H1036_275_2	5	1				07/18/2018	2019.01	07/18/2018 05:26:27 PM Eastern Daylight Time	07/17/2018 10:33:16 AM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-275 (HMO)	01	01		1			H1036	275	2	2019	Greensboro - Winston Salem Metro Area	Greensboro - Winston Salem	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	276	0	1	01	01	H1036_276_0	5	1	2	1		07/16/2018	2019.01	07/16/2018 01:05:36 PM Eastern Daylight Time	08/03/2018 09:55:48 AM Eastern Daylight Time	08/03/2018 09:21:02 AM Eastern Daylight Time			08/06/2018 10:31:27 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-276 (HMO SNP)	01	01		1			H1036	276	0	2019	Raleigh Metro Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	277	0	1	01	01	H1036_277_0	5	1				07/02/2018	2019.01	07/02/2018 01:40:42 PM Eastern Daylight Time	07/16/2018 04:45:50 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-277 (HMO)	01	01		1			H1036	277	0	2019	Lake, Marion and Sumter counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	278	0	1	01	01	H1036_278_0	5	1				07/02/2018	2019.01	07/02/2018 01:40:49 PM Eastern Daylight Time	08/03/2018 03:21:53 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-278 (HMO)	01	01		1			H1036	278	0	2019	Charlotte, Collier and Lee counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	801	0	1	01	01	H1036_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:20:14 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	801	0	2019	Select counties in Florida		1	71483	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1036	806	0	1	01	01	H1036_806_0	1	1				05/31/2018	2019.01	05/31/2018 12:21:06 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	806	0	2019	Select counties in Florida		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1036	810	0	1	01	01	H1036_810_0	1	1				05/31/2018	2019.01	05/31/2018 12:22:18 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	810	0	2019	Select Counties in MS, OR and NC		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1036	811	0	1	01	01	H1036_811_0	1	1				05/31/2018	2019.01	05/31/2018 12:22:39 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	811	0	2019	Select Counties in MS, OR and NC		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1043	001	0	1	20	08	H1043_001_0	1	1				05/23/2018	2019.01	05/23/2018 10:36:24 AM Eastern Daylight Time		05/23/2018 10:24:40 AM Eastern Daylight Time			05/23/2018 10:37:35 AM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	miamijewishhealthsystems.org	Florida PACE Centers, Inc. (PACE)	08	20		1			H1043	001	0	2019	Florida PACE Centers, Inc.		2		2			2						www.floridapace.org	www.noformulary.com										(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	66725									(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	66725															
H1043	002	0	1	20	08	H1043_002_0	1	1				05/08/2018	2019.01	05/08/2018 03:39:45 PM Eastern Daylight Time		05/23/2018 10:24:40 AM Eastern Daylight Time			05/23/2018 10:43:31 AM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	miamijewishhealthsystems.org	Florida PACE Centers, Inc (PACE)	08	20		1			H1043	002	0	2019	Florida PACE Centers, Inc.		2		2			2						www.floridapace.org	www.noformulary.com										(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	8465									(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	8465															
H1045	001	0	1	01	01	H1045_001_0	2	1				08/02/2018	2019.01	08/02/2018 03:47:20 PM Central Daylight Time	08/03/2018 09:39:15 AM Central Daylight Time	07/31/2018 05:52:02 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Dade (HMO)	01	01		1			H1045	001	0	2019	Miami-Dade County		2		2			2						www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	005	0	1	01	01	H1045_005_0	2	1				08/02/2018	2019.01	08/02/2018 03:47:48 PM Central Daylight Time	08/03/2018 09:39:47 AM Central Daylight Time	07/31/2018 05:52:24 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Broward (HMO)	01	01		1			H1045	005	0	2019	Broward County		2		2			2						www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	012	0	1	01	01	H1045_012_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:07:53 PM Central Daylight Time	08/03/2018 09:40:19 AM Central Daylight Time	07/31/2018 05:52:46 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist (HMO SNP)	01	01		1			H1045	012	0	2019	Miami-Dade and Broward Counties		2		2			1	3		2		2	www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	018	0	1	01	01	H1045_018_0	2	1		1		08/02/2018	2019.01	08/02/2018 03:48:53 PM Central Daylight Time	08/03/2018 09:40:51 AM Central Daylight Time	07/31/2018 05:53:14 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Special Care Miami-Dade (HMO SNP)	01	01		1			H1045	018	0	2019	Miami-Dade County		2		2			1	4			00000000000000000010		www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	025	0	1	01	01	H1045_025_0	3	1				08/02/2018	2019.01	08/02/2018 03:49:33 PM Central Daylight Time	08/03/2018 09:41:23 AM Central Daylight Time	07/31/2018 05:53:42 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages MedicareComplete 1 (HMO)	01	01		1			H1045	025	0	2019	Lake, Marion and Sumter counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	026	0	1	01	01	H1045_026_0	2	1				08/02/2018	2019.01	08/02/2018 03:51:08 PM Central Daylight Time	08/03/2018 09:41:55 AM Central Daylight Time	07/31/2018 05:54:04 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	026	0	2019	Select Counties in Jacksonville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	027	0	1	02	01	H1045_027_0	3	1				05/24/2018	2019.01	05/24/2018 11:37:45 AM Central Daylight Time	08/03/2018 09:42:27 AM Central Daylight Time	07/31/2018 05:54:28 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages MedicareComplete 2 (HMO-POS)	01	02		1			H1045	027	0	2019	Lake, Marion and Sumter counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	028	0	1	01	01	H1045_028_0	2	1				08/02/2018	2019.01	08/02/2018 03:55:45 PM Central Daylight Time	08/03/2018 09:43:00 AM Central Daylight Time	07/31/2018 05:54:52 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	028	0	2019	Select Counties in Central Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	030	0	1	01	01	H1045_030_0	2	1				08/02/2018	2019.01	08/02/2018 03:57:05 PM Central Daylight Time	08/03/2018 09:43:33 AM Central Daylight Time	07/31/2018 05:55:14 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	030	0	2019	Brevard, Orange, Osceola and Seminole counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	031	0	1	01	01	H1045_031_0	2	1				08/02/2018	2019.01	08/02/2018 03:57:43 PM Central Daylight Time	08/03/2018 09:44:05 AM Central Daylight Time	07/31/2018 05:55:36 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	031	0	2019	Escambia, Okaloosa and Santa Rosa counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	032	0	1	01	01	H1045_032_0	2	1				08/02/2018	2019.01	08/02/2018 03:59:03 PM Central Daylight Time	08/03/2018 09:44:38 AM Central Daylight Time	07/31/2018 05:56:00 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	032	0	2019	Bay and Walton counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	033	0	1	01	01	H1045_033_0	2	1				08/02/2018	2019.01	08/02/2018 04:00:16 PM Central Daylight Time	08/03/2018 09:45:11 AM Central Daylight Time	07/31/2018 05:56:22 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	033	0	2019	Select counties in Gainesville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	034	0	1	01	01	H1045_034_0	2	1				08/02/2018	2019.01	08/02/2018 04:01:19 PM Central Daylight Time	08/03/2018 09:45:43 AM Central Daylight Time	07/31/2018 05:56:44 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1045	034	0	2019	Select counties in Fort Myers/Naples Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	036	0	1	01	01	H1045_036_0	2	1				08/02/2018	2019.01	08/02/2018 04:02:23 PM Central Daylight Time	08/03/2018 09:46:17 AM Central Daylight Time	07/31/2018 05:57:06 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H1045	036	0	2019	Indian River, Martin and St. Lucie counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	037	0	1	01	01	H1045_037_0	2	1				08/02/2018	2019.01	08/02/2018 04:03:13 PM Central Daylight Time	08/03/2018 09:46:50 AM Central Daylight Time	07/31/2018 05:57:30 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Palm Beach (HMO)	01	01		1			H1045	037	0	2019	Palm Beach county		2		2			2						www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	038	0	1	01	01	H1045_038_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 01:08:06 PM Central Daylight Time	08/03/2018 09:47:23 AM Central Daylight Time	07/31/2018 05:57:52 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist Palm Beach (HMO SNP)	01	01		1			H1045	038	0	2019	Palm Beach county		2		2			1	3		2		2	www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	039	0	1	01	01	H1045_039_0	3	1	2	1		07/20/2018	2019.01	07/20/2018 12:54:57 PM Central Daylight Time	08/03/2018 09:47:56 AM Central Daylight Time	07/31/2018 05:58:16 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO SNP)	01	01		1			H1045	039	0	2019	Select counties in Central Florida		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	041	0	1	01	01	H1045_041_0	2	1				08/02/2018	2019.01	08/02/2018 04:04:19 PM Central Daylight Time	08/03/2018 09:48:28 AM Central Daylight Time	07/31/2018 05:58:38 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	041	0	2019	Select counties in Tallahassee		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	042	0	1	01	01	H1045_042_0	2	1				08/02/2018	2019.01	08/02/2018 04:05:13 PM Central Daylight Time	08/03/2018 09:49:01 AM Central Daylight Time	07/31/2018 05:59:02 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	042	0	2019	DeSoto, Highlands, and Hardee counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	043	0	1	01	01	H1045_043_0	2	1				08/02/2018	2019.01	08/02/2018 04:06:12 PM Central Daylight Time	08/03/2018 09:49:33 AM Central Daylight Time	07/31/2018 05:59:26 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	043	0	2019	Citrus and Levy counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	045	0	1	01	01	H1045_045_0	3	1				08/02/2018	2019.01	08/02/2018 04:07:04 PM Central Daylight Time	08/03/2018 09:50:06 AM Central Daylight Time	07/31/2018 05:59:48 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H1045	045	0	2019	Select Counties in Tampa		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	046	0	1	01	01	H1045_046_0	3	1				08/02/2018	2019.01	08/02/2018 04:07:54 PM Central Daylight Time	08/03/2018 09:50:38 AM Central Daylight Time	07/31/2018 06:00:14 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Complete Care (HMO)	01	01		1			H1045	046	0	2019	Miami-Dade County		2		2			2						www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	801	0	1	01	01	H1045_801_0	1	1				05/25/2018	2019.01	05/25/2018 02:46:50 PM Central Daylight Time					06/02/2018 12:10:11 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	801	0	2019	Select counties in Florida		1	516	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1045	802	0	1	01	01	H1045_802_0	1	1				05/25/2018	2019.01	05/25/2018 02:07:56 PM Central Daylight Time					06/02/2018 12:10:11 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	802	0	2019	Select counties in Florida		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H1045	803	0	1	01	01	H1045_803_0	1	1				05/25/2018	2019.01	05/25/2018 02:47:02 PM Central Daylight Time					06/02/2018 12:10:11 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	803	0	2019	Select counties in Florida		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1045	804	0	2	01	01	H1045_804_0	1	1				05/25/2018	2019.01	05/25/2018 02:47:14 PM Central Daylight Time					06/02/2018 12:10:11 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1045	804	0	2019	Select counties in Florida		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1099	001	0	1	02	01	H1099_001_0	4	1				05/18/2018	2019.01	05/18/2018 06:40:31 PM Eastern Daylight Time	07/31/2018 09:00:35 PM Eastern Daylight Time	08/01/2018 11:24:18 AM Eastern Daylight Time			08/01/2018 05:06:54 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	Health First Classic Plan (HMO-POS)	01	02		1			H1099	001	0	2019	Counties: BR, IR		2	126786	2			2						myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2	2			
H1099	006	0	1	01	01	H1099_006_0	4	1				05/18/2018	2019.01	05/18/2018 06:35:53 PM Eastern Daylight Time	07/31/2018 08:44:36 PM Eastern Daylight Time	08/01/2018 11:25:34 AM Eastern Daylight Time			08/01/2018 05:06:54 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	Health First Value Plan (HMO)	01	01		1			H1099	006	0	2019	Counties: BR, IR		2	117568	2			2						myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2	2			
H1099	009	0	1	01	01	H1099_009_0	3	1				05/18/2018	2019.01	05/18/2018 06:37:17 PM Eastern Daylight Time	06/01/2018 11:35:02 AM Eastern Daylight Time				06/01/2018 03:15:10 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	Health First Secure Plan (HMO)	01	01		1			H1099	009	0	2019	Counties: BR, IR		2	6144	2			2						myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771										2					2					2	2			
H1099	014	0	1	01	01	H1099_014_0	4	1				05/18/2018	2019.01	05/18/2018 06:36:51 PM Eastern Daylight Time	07/31/2018 08:28:28 PM Eastern Daylight Time	08/01/2018 11:26:40 AM Eastern Daylight Time			08/01/2018 05:06:54 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	Health First Rewards Plan (HMO)	01	01		1			H1099	014	0	2019	Counties: BR, IR		2	95140	2			2						myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2	2			
H1099	016	0	1	01	01	H1099_016_0	3	1				05/18/2018	2019.01	05/18/2018 06:37:36 PM Eastern Daylight Time	07/31/2018 06:05:31 PM Eastern Daylight Time	08/01/2018 11:28:06 AM Eastern Daylight Time			08/01/2018 05:06:54 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myFHCA.org	Florida Hospital SunSaver Plan (HMO)	01	01		1			H1099	016	0	2019	Counties: VO, FL, HA, HI, SE		2	97739	2			2						myFHCA.org	myFHCA.org	myFHCA.org	(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2	2			
H1099	802	0	1	01	01	H1099_802_0	1	1				05/18/2018	2019.01	05/18/2018 06:37:50 PM Eastern Daylight Time					05/22/2018 11:33:13 AM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	EMPLOYER GROUP PLUS (HMO)	01	01		1			H1099	802	0	2019	Central Florida Area		1	13880	2			2						myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	1	1a;1b;2;3-1;3-2;3-3;6;7c;7i;8a;8b1;8b2;9a1;9b;9d;11a;11b;11c;14e2;16b;	2		1					1				
H1099	804	0	1	02	01	H1099_804_0	1	1				05/21/2018	2019.01	05/21/2018 12:19:36 PM Eastern Daylight Time					05/22/2018 11:33:13 AM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	EMPLOYER GROUP POS (HMO-POS)	01	02		1			H1099	804	0	2019	Central Florida Area		1	940	2			2						myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	1	1a;1b;2;3-1;3-2;3-3;6;7c;7i;8a;8b1;8b2;9a1;9b;9d;11a;11b;11c;14e2;16b;	2		1	1	1a;1b;2;3-1;3-2;6;7c;7i;8a;8b1;8b2;9a1;9b;14e2;16b;	2		1				
H1100	001	0	1	04	01	H1100_001_0	5	1				07/11/2018	2019.01	07/11/2018 01:20:21 PM Eastern Daylight Time	08/02/2018 12:00:25 PM Eastern Daylight Time	07/31/2018 05:47:20 PM Eastern Daylight Time			08/04/2018 09:29:10 PM Eastern Daylight Time	INNOVATION HEALTH INSURANCE COMPANY	Innovation Health Medicare	www.innovationhealthmedicare.com	Innovation Health Medicare Voyager Plan (PPO)	01	04		1			H1100	001	0	2019	Fairfax County and Surrounding Area		2		2			2						www.innovationhealthmedicare.com/findpharmacy	www.innovationhealthmedicare.com/formulary	www.innovationhealthmedicare.com/findprovider	(855)249-1282		(855)249-1282		(855)605-5295		(855)605-5295		(855)249-1282		(855)249-1282		(855)605-5295		(855)605-5295		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;7a;7d;7g;	
H1109	005	0	1	01	01	H1109_005_0	4	1				08/01/2018	2019.01	08/01/2018 01:54:04 PM Eastern Daylight Time	08/02/2018 11:41:59 AM Eastern Daylight Time	07/31/2018 10:42:12 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	005	0	2019	Atlanta and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1109	006	0	1	01	01	H1109_006_0	3	1				08/02/2018	2019.01	08/02/2018 11:40:54 AM Eastern Daylight Time	08/02/2018 11:42:44 AM Eastern Daylight Time	07/31/2018 10:43:06 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	006	0	2019	Hall County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1109	801	0	1	01	01	H1109_801_0	3	1				06/04/2018	2019.01	06/04/2018 12:02:29 PM Eastern Daylight Time					06/04/2018 12:11:45 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1109	801	0	2019	Georgia		1	1530	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-1637		(888)267-1637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H1109	802	0	1	01	01	H1109_802_0	2	1				06/01/2018	2019.01	06/01/2018 10:23:27 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H1109	802	0	2019	Georgia		1	6960	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H1111	006	0	1	01	01	H1111_006_0	3	1				08/02/2018	2019.01	08/02/2018 12:46:21 PM Central Daylight Time	08/03/2018 09:36:05 AM Central Daylight Time	07/31/2018 06:00:36 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1111	006	0	2019	Select counties in Georgia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	007	0	1	01	01	H1111_007_0	3	1				07/12/2018	2019.01	07/12/2018 11:20:32 AM Central Daylight Time	08/03/2018 09:36:47 AM Central Daylight Time	07/31/2018 06:00:58 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1111	007	0	2019	Select counties in Georgia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	801	0	1	01	01	H1111_801_0	1	1				05/30/2018	2019.01	05/30/2018 12:42:34 PM Central Daylight Time					06/02/2018 12:49:56 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	801	0	2019	GA Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1111	804	0	1	01	01	H1111_804_0	1	1				05/30/2018	2019.01	05/30/2018 12:43:12 PM Central Daylight Time					06/02/2018 12:49:56 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	804	0	2019	GA Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H1111	805	0	1	01	01	H1111_805_0	1	1				05/30/2018	2019.01	05/30/2018 12:43:26 PM Central Daylight Time					06/02/2018 12:49:56 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	805	0	2019	GA Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1111	807	0	2	01	01	H1111_807_0	1	1				05/30/2018	2019.01	05/30/2018 12:43:38 PM Central Daylight Time					06/02/2018 12:49:56 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1111	807	0	2019	GA Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1112	006	0	1	01	01	H1112_006_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 12:52:18 PM Eastern Daylight Time	08/06/2018 04:47:10 PM Eastern Daylight Time	08/01/2018 02:18:50 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1112	006	0	2019	Select Counties in GA		2	174255	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	033	0	1	01	01	H1112_033_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 12:50:47 PM Eastern Daylight Time	08/06/2018 04:47:57 PM Eastern Daylight Time	08/01/2018 02:19:11 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H1112	033	0	2019	Select Counties in GA		2	52486	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	034	0	1	02	01	H1112_034_0	3	1				05/23/2018	2019.01	05/23/2018 11:40:50 AM Eastern Daylight Time	06/02/2018 01:55:01 AM Eastern Daylight Time				06/02/2018 10:41:32 AM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	01	02		1			H1112	034	0	2019	Select Counties in GA		2	13372	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-7730		(866)334-7730		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1112	035	0	1	01	01	H1112_035_0	4	1				08/03/2018	2019.01	08/03/2018 12:49:04 PM Eastern Daylight Time	08/06/2018 04:49:28 PM Eastern Daylight Time	08/01/2018 02:19:31 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	01	01		1			H1112	035	0	2019	Cobb County		2	7472	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-7730		(866)334-7730		(866)527-0056		(866)527-0056		(866)334-7730		(866)334-7730		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	036	1	1	01	01	H1112_036_1	4	1				08/03/2018	2019.01	08/03/2018 12:48:20 PM Eastern Daylight Time	08/06/2018 04:50:14 PM Eastern Daylight Time	08/01/2018 02:19:52 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1112	036	1	2019	Select Counties in GA	Select Counties in GA	2	223621	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	036	3	1	01	01	H1112_036_3	4	1				08/03/2018	2019.01	08/03/2018 12:47:44 PM Eastern Daylight Time	08/06/2018 04:50:59 PM Eastern Daylight Time	08/01/2018 02:20:13 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1112	036	3	2019	Select Counties in GA	Select GA Counties	2	137684	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1119	001	0	1	01	01	H1119_001_0	9	1		1		07/13/2018	2019.01	07/13/2018 09:38:07 AM Eastern Daylight Time	08/07/2018 11:58:52 AM Eastern Daylight Time	08/07/2018 11:58:52 AM Eastern Daylight Time			08/07/2018 11:59:44 AM Eastern Daylight Time	TSG GUARD, INC.	Valor Health Plan	www.valorhealthplan.com	Valor Health Plan (HMO SNP)	01	01		1			H1119	001	0	2019	Northeast and Central Ohio		2	2652	2			1	1	1				www.valorhealthplan.com	www.valorhealthplan.com	www.valorhealthplan.com	(844)386-3111		(501)255-0109		(844)386-3111		(501)255-0109		(844)386-3111		(501)255-0109		(844)386-3111		(501)255-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H1142	001	0	1	01	01	H1142_001_0	9	1				08/03/2018	2019.01	08/03/2018 02:04:05 PM Central Daylight Time	08/02/2018 01:18:06 PM Central Daylight Time	08/02/2018 11:02:50 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage (HMO)	01	01		1			H1142	001	0	2019	Cincinnati, Toledo, and Youngstown Metro Areas		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1142	002	0	1	01	01	H1142_002_0	9	1				06/04/2018	2019.01	06/04/2018 04:58:20 PM Central Daylight Time	08/02/2018 01:19:00 PM Central Daylight Time	08/02/2018 11:03:30 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Plus (HMO)	01	01		1			H1142	002	0	2019	Cincinnati, Toledo, and Youngstown Metro Areas		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	002	0	1	01	01	H1170_002_0	7	1				08/03/2018	2019.01	08/03/2018 11:57:47 AM Eastern Daylight Time	08/03/2018 02:20:54 PM Eastern Daylight Time	08/03/2018 02:26:31 PM Eastern Daylight Time			08/06/2018 01:32:28 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H1170	002	0	2019	Atlanta Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	008	0	1	01	01	H1170_008_0	8	1	2	1		08/06/2018	2019.01	08/06/2018 07:47:25 AM Eastern Daylight Time	08/03/2018 06:09:19 PM Eastern Daylight Time	08/03/2018 02:31:12 PM Eastern Daylight Time			08/06/2018 01:32:28 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid Plan (HMO SNP)	01	01		1			H1170	008	0	2019	Atlanta Metro Area		2		2			1	3		2		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	009	0	1	01	01	H1170_009_0	8	1				08/03/2018	2019.01	08/03/2018 12:00:52 PM Eastern Daylight Time	08/03/2018 02:22:11 PM Eastern Daylight Time	08/03/2018 02:28:40 PM Eastern Daylight Time			08/06/2018 01:32:28 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H1170	009	0	2019	Atlanta Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	801	0	1	01	01	H1170_801_0	4	1				06/01/2018	2019.01	06/01/2018 06:04:58 PM Eastern Daylight Time					06/04/2018 02:43:55 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group Plan (HMO)	01	01		1			H1170	801	0	2019	Atlanta Metro Area		1	1	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;16b;	1					2				
H1170	802	0	1	01	01	H1170_802_0	4	1				05/16/2018	2019.01	05/16/2018 04:30:37 PM Eastern Daylight Time					06/04/2018 02:43:55 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Employer Group With Part D (HMO)	01	01		1			H1170	802	0	2019	Atlanta Metro Area		1	53093	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;16b;	1					2				
H1170	805	0	1	01	01	H1170_805_0	4	1				05/16/2018	2019.01	05/16/2018 04:31:09 PM Eastern Daylight Time					06/04/2018 02:43:55 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB  with D (HMO)	01	01		1			H1170	805	0	2019	Atlanta Metro Area		1	19762	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;16b;	1					2				
H1181	001	0		07	02	H1181_001_0	4	2				05/29/2018	2019.01	05/29/2018 08:33:46 AM Central Daylight Time			06/01/2018 03:34:04 PM Central Daylight Time		06/04/2018 01:50:02 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	NetworkPrime (MSA)	02	07	2				H1181	001	0	2019	Wisconsin		2		2			2									(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529																								
H1189	001	0	1	01	01	H1189_001_0	9	1				08/06/2018	2019.01	08/06/2018 03:27:39 PM Pacific Daylight Time	08/06/2018 05:07:21 PM Pacific Daylight Time	07/31/2018 02:31:46 PM Pacific Daylight Time			08/06/2018 05:58:30 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org	CHRISTUS Health Plan Generations (HMO)	01	01		1			H1189	001	0	2019	North Central New Mexico		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	10		13a;
H1189	002	0	1	01	01	H1189_002_0	9	1				08/06/2018	2019.01	08/06/2018 03:27:55 PM Pacific Daylight Time	08/06/2018 05:08:33 PM Pacific Daylight Time	07/31/2018 02:33:03 PM Pacific Daylight Time			08/06/2018 05:58:30 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org	CHRISTUS Health Plan Generations Plus (HMO)	01	01		1			H1189	002	0	2019	North Central New Mexico		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	10		13a;
H1189	003	0	1	01	01	H1189_003_0	8	1				08/06/2018	2019.01	08/06/2018 03:28:08 PM Pacific Daylight Time	08/06/2018 05:09:48 PM Pacific Daylight Time	07/31/2018 02:33:53 PM Pacific Daylight Time			08/06/2018 05:58:30 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org/	CHRISTUS Health Plan Generations (HMO)	01	01		1			H1189	003	0	2019	Cherokee, Smith and Wood counties		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1189	004	0	1	01	01	H1189_004_0	8	1				08/06/2018	2019.01	08/06/2018 03:28:22 PM Pacific Daylight Time	08/06/2018 05:12:11 PM Pacific Daylight Time	07/31/2018 02:34:38 PM Pacific Daylight Time			08/06/2018 05:58:30 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org/	CHRISTUS Health Plan Generations Plus (HMO)	01	01		1			H1189	004	0	2019	Cherokee, Smith and Wood counties		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	001	0	1	01	01	H1205_001_0	9	1	2	1		08/02/2018	2019.01	08/02/2018 01:35:22 PM Eastern Daylight Time	08/03/2018 07:39:30 PM Eastern Daylight Time	08/03/2018 07:40:17 PM Eastern Daylight Time			08/03/2018 07:42:06 PM Eastern Daylight Time	INTEGRA MLTC, INC.	Integra Managed Care	http://www.integraplan.org	Integra Harmony Plan (HMO SNP)	01	01		1			H1205	001	0	2019	Bronx, Kings, Queens and New York counties		2	1126	2			1	3		2		1	integraplan.org	integraplan.org				(855)800-4683	3413			(855)800-4683		(183)345-9442		(183)345-9442		(855)800-4683	3413	(855)800-4683	3413	(711)-	711	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	002	0	1	01	01	H1205_002_0	11	1	2	1		08/02/2018	2019.01	08/02/2018 01:36:06 PM Eastern Daylight Time	08/04/2018 03:36:46 PM Eastern Daylight Time	08/04/2018 03:36:46 PM Eastern Daylight Time			08/04/2018 03:38:59 PM Eastern Daylight Time	INTEGRA MLTC, INC.	Integra Managed Care	integraplan.org	Integra Synergy Plan (HMO SNP)	01	01		1			H1205	002	0	2019	Bronx, Kings, Queens and New York counties		2	1126	2			1	3		1		1	integraplan.org	integraplan.org				(855)800-4683	3413			(855)800-4683	3413	(833)459-4422		(833)459-4422		(855)800-4683	3413	(855)800-4683	3413	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	005	0	1	01	01	H1205_005_0	8	1	2	1		08/02/2018	2019.01	08/02/2018 01:36:06 PM Eastern Daylight Time	08/03/2018 07:39:31 PM Eastern Daylight Time	08/03/2018 07:40:18 PM Eastern Daylight Time			08/03/2018 07:42:06 PM Eastern Daylight Time	INTEGRA MLTC, INC.	Integra Managed Care	http://www.integraplan.org	Integra Harmony Plan (HMO SNP)	01	01		1			H1205	005	0	2019	Nassau County		2	53	2			1	3		2		1	integraplan.org	integraplan.org				(855)800-4683	3413			(855)800-4683		(183)345-9442		(183)345-9442		(855)800-4683	3413	(855)800-4683	3413	(711)-	711	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	006	0	1	01	01	H1205_006_0	9	1	2	1		08/02/2018	2019.01	08/02/2018 01:36:51 PM Eastern Daylight Time	08/03/2018 07:39:32 PM Eastern Daylight Time	08/03/2018 07:40:18 PM Eastern Daylight Time			08/03/2018 07:42:06 PM Eastern Daylight Time	INTEGRA MLTC, INC.	Integra Managed Care	http://www.integraplan.org	Integra Synergy Plan (HMO SNP)	01	01		1			H1205	006	0	2019	Nassau County		2	53	2			1	3		1		1	integraplan.org	integraplan.org				(855)800-4683	3413			(855)800-4683		(183)345-9442		(183)345-9442		(855)800-4683	3413	(855)800-4683	3413	(711)-	711	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1225	001	0	1	01	01	H1225_001_0	10	1				08/06/2018	2019.01	08/06/2018 10:05:23 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time			08/06/2018 10:06:35 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	http://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (HMO)	01	01		1			H1225	001	0	2019	Counties: AA BL CV CR FR HW MG SS WH WC WR		2	43764	2			2						http://www.hopkinsmedicare.com/	http://www.hopkinsmedicare.com/	http://www.hopkinsmedicare.com/	(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1225	002	0	1	01	01	H1225_002_0	10	1				08/06/2018	2019.01	08/06/2018 10:05:39 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time			08/06/2018 10:06:35 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	http://www.hopkinsmedicare.com	Johns Hopkins Advantage MD (HMO)	01	01		1			H1225	002	0	2019	Baltimore City		2	11310	2			2						http://www.hopkinsmedicare.com	http://www.hopkinsmedicare.com	http://www.hopkinsmedicare.com	(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1230	001	0	1	01	01	H1230_001_0	12	1				06/04/2018	2019.01	06/04/2018 10:59:44 AM Hawaiian Standard Time	08/02/2018 11:22:53 AM Hawaiian Standard Time	08/02/2018 11:37:58 AM Hawaiian Standard Time			08/06/2018 10:42:57 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H1230	001	0	2019	Island of Oahu		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1230	003	0	1	01	01	H1230_003_0	12	1				06/02/2018	2019.01	06/02/2018 09:35:06 AM Hawaiian Standard Time	08/02/2018 11:24:08 AM Hawaiian Standard Time	08/02/2018 11:39:24 AM Hawaiian Standard Time			08/06/2018 10:42:57 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H1230	003	0	2019	Island of Oahu		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1230	008	0	1	01	01	H1230_008_0	12	1	2	1		07/31/2018	2019.01	07/31/2018 02:45:17 PM Hawaiian Standard Time	08/02/2018 11:25:28 AM Hawaiian Standard Time	08/03/2018 11:06:28 AM Hawaiian Standard Time			08/06/2018 10:42:57 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO SNP)	01	01		1			H1230	008	0	2019	Islands of Oahu and Maui		2		2			1	3		1		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1230	013	0	1	01	01	H1230_013_0	14	1				06/02/2018	2019.01	06/02/2018 09:35:48 AM Hawaiian Standard Time	08/02/2018 11:26:55 AM Hawaiian Standard Time	08/02/2018 11:42:12 AM Hawaiian Standard Time			08/06/2018 10:42:57 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Maui (HMO)	01	01		1			H1230	013	0	2019	Island of Maui		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1230	014	0	1	01	01	H1230_014_0	12	1				06/02/2018	2019.01	06/02/2018 09:36:19 AM Hawaiian Standard Time	08/02/2018 11:28:15 AM Hawaiian Standard Time	08/02/2018 11:43:39 AM Hawaiian Standard Time			08/06/2018 10:42:57 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Hawaii Island (HMO)	01	01		1			H1230	014	0	2019	Island of Hawaii except for 3 ZIPs		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1230	801	0	1	01	01	H1230_801_0	10	1				05/30/2018	2019.01	05/30/2018 11:38:01 AM Hawaiian Standard Time					06/04/2018 09:37:27 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA only (HMO)	01	01		1			H1230	801	0	2019	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	1156	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e2;14e3;14e5;16b;17a;17b;18a;	1					2				
H1230	803	0	1	01	01	H1230_803_0	10	1				05/30/2018	2019.01	05/30/2018 11:39:08 AM Hawaiian Standard Time					06/04/2018 09:37:27 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA-PD (HMO)	01	01		1			H1230	803	0	2019	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	161459	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e2;14e3;14e5;16b;17a;17b;18a;	1					2				
H1230	804	0	2	01	01	H1230_804_0	11	1				06/25/2018	2019.01	06/25/2018 10:03:30 AM Hawaiian Standard Time					06/25/2018 10:16:57 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA-PD Part B (HMO)	01	01		2	1		H1230	804	0	2019	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	286	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e2;14e3;14e5;16b;17a;17b;18a;	1					2				
H1230	805	0	1	01	01	H1230_805_0	10	1				05/30/2018	2019.01	05/30/2018 11:40:48 AM Hawaiian Standard Time					06/04/2018 09:37:27 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H1230	805	0	2019	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	25369	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e2;14e3;14e5;16b;17a;17b;18a;	1					2				
H1230	806	0	2	01	01	H1230_806_0	10	1				05/30/2018	2019.01	05/30/2018 11:42:00 AM Hawaiian Standard Time					06/04/2018 09:37:27 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H1230	806	0	2019	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	256	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e2;14e3;14e5;16b;17a;17b;18a;	1					2				
H1234	001	0	1	20	08	H1234_001_0	1	1				06/01/2018	2019.01	06/01/2018 11:10:37 AM Eastern Daylight Time		06/01/2018 11:03:07 AM Eastern Daylight Time			06/01/2018 11:12:23 AM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Dual (PACE)	08	20		1			H1234	001	0	2019	Mercer County and portions of Burlington County		2		2			2						www.pharmastarpbm.com	www.stfrancismedical.org										(609)599-5478		(609)599-5478		(609)599-5478		(609)599-5478										(609)599-5478		(609)599-5478		(609)599-5478		(609)599-5478																
H1234	002	0	1	20	08	H1234_002_0	1	1				06/01/2018	2019.01	06/01/2018 11:10:57 AM Eastern Daylight Time		06/01/2018 11:03:51 AM Eastern Daylight Time			06/01/2018 11:12:23 AM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Medicare only (PACE)	08	20		1			H1234	002	0	2019	Mercer County and portions of Burlington County		2		2			2						www.pharmastarpbm.com	www.stfrancismedical.org										(609)599-5478		(609)599-5478		(609)599-5478		(609)599-5478										(609)599-5478		(609)599-5478		(609)599-5478		(609)599-5478																
H1239	001	0	1	20	08	H1239_001_0	2	1				05/23/2018	2019.01	05/23/2018 02:14:03 PM Mountain Daylight Time		05/23/2018 02:04:12 PM Mountain Daylight Time			05/23/2018 02:42:55 PM Mountain Daylight Time	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	InnovAge Virginia PACE- Roanoke Valley	www.MyInnovAge.com	InnovAge Virginia PACE- Roanoke Valley (PACE)	08	20		1			H1239	001	0	2019	Roanoke Valley Area		2		2			2						https://www.granerx.com/	http://myinnovage.org										(540)904-2817		(540)904-2817		(540)904-2817		(540)904-2817										(540)904-2817		(540)904-2817		(540)904-2817		(540)904-2817																
H1239	002	0	1	20	08	H1239_002_0	2	1				05/23/2018	2019.01	05/23/2018 02:14:24 PM Mountain Daylight Time		05/23/2018 02:04:27 PM Mountain Daylight Time			05/23/2018 02:42:55 PM Mountain Daylight Time	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	InnovAge Virginia PACE- Roanoke Valley	www.MyInnovAge.com	InnovAge Virginia PACE- Roanoke Valley (PACE)	08	20		1			H1239	002	0	2019	Roanoke Valley Area		2		2			2						https://www.granerx.com/	http://myinnovage.org										(540)904-2817		(540)904-2817		(540)904-2817		(540)904-2817										(540)904-2817		(540)904-2817		(540)904-2817		(540)904-2817																
H1248	001	0	1	04	01	H1248_001_0	7	1				08/09/2018	2019.01	08/09/2018 01:51:24 PM Central Daylight Time	08/06/2018 04:29:18 PM Central Daylight Time	08/06/2018 04:28:40 PM Central Daylight Time			08/10/2018 02:44:28 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	001	0	2019	Baton Rouge		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	002	0	1	04	01	H1248_002_0	7	1				08/09/2018	2019.01	08/09/2018 01:56:04 PM Central Daylight Time	08/06/2018 04:29:19 PM Central Daylight Time	08/06/2018 04:28:41 PM Central Daylight Time			08/10/2018 02:44:28 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	002	0	2019	Greater New Orleans		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	003	0	1	04	01	H1248_003_0	7	1				08/09/2018	2019.01	08/09/2018 01:58:43 PM Central Daylight Time	08/06/2018 04:29:20 PM Central Daylight Time	08/06/2018 04:28:41 PM Central Daylight Time			08/10/2018 02:44:28 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	003	0	2019	North Shore		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	004	0	1	04	01	H1248_004_0	7	1				08/09/2018	2019.01	08/09/2018 02:01:05 PM Central Daylight Time	08/06/2018 04:29:21 PM Central Daylight Time	08/06/2018 04:28:35 PM Central Daylight Time			08/10/2018 02:44:28 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	004	0	2019	Acadiana		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	005	0	1	04	01	H1248_005_0	7	1				08/09/2018	2019.01	08/09/2018 02:03:46 PM Central Daylight Time	08/06/2018 04:29:09 PM Central Daylight Time	08/06/2018 04:28:35 PM Central Daylight Time			08/10/2018 02:44:28 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	005	0	2019	Northwest		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	006	0	1	04	01	H1248_006_0	7	1				08/09/2018	2019.01	08/09/2018 02:07:52 PM Central Daylight Time	08/06/2018 04:29:10 PM Central Daylight Time	08/06/2018 04:28:36 PM Central Daylight Time			08/10/2018 02:44:28 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	006	0	2019	Northeast		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	801	0	1	04	01	H1248_801_0	4	1				05/22/2018	2019.01	05/22/2018 11:16:28 AM Central Daylight Time					06/04/2018 01:10:23 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	801	0	2019	State of Louisiana		1	250	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1									
H1248	802	0	1	04	01	H1248_802_0	4	1				05/22/2018	2019.01	05/22/2018 11:16:53 AM Central Daylight Time					06/04/2018 01:10:23 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	802	0	2019	State of Louisiana		1	250	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1									
H1248	803	0	1	04	01	H1248_803_0	4	1				05/22/2018	2019.01	05/22/2018 11:17:24 AM Central Daylight Time					06/04/2018 01:10:23 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	803	0	2019	State of Louisiana		1	250	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1									
H1278	001	0	1	04	01	H1278_001_0	4	1				07/12/2018	2019.01	07/12/2018 11:54:06 AM Central Daylight Time	08/03/2018 09:37:26 AM Central Daylight Time	07/31/2018 06:01:22 PM Central Daylight Time			08/06/2018 12:20:58 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H1278	001	0	2019	Select Counties in Nebraska		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	002	0	1	04	01	H1278_002_0	4	1				07/12/2018	2019.01	07/12/2018 11:54:33 AM Central Daylight Time	08/03/2018 09:38:06 AM Central Daylight Time	07/31/2018 06:01:46 PM Central Daylight Time			08/06/2018 12:20:58 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H1278	002	0	2019	Select Counties in Nebraska		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	003	0	1	04	01	H1278_003_0	6	1				07/12/2018	2019.01	07/12/2018 11:45:02 AM Central Daylight Time	08/03/2018 09:38:45 AM Central Daylight Time	07/31/2018 06:02:08 PM Central Daylight Time			08/06/2018 09:07:56 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H1278	003	0	2019	Andrews, Ector, Midland, and Tom Green counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	004	0	1	04	01	H1278_004_0	6	1				07/12/2018	2019.01	07/12/2018 11:45:31 AM Central Daylight Time	08/03/2018 09:39:23 AM Central Daylight Time	07/31/2018 06:02:30 PM Central Daylight Time			08/06/2018 09:07:56 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H1278	004	0	2019	Atascosa,Hays,Travis, and Williamson counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	005	0	1	04	01	H1278_005_0	6	1				07/12/2018	2019.01	07/12/2018 11:46:00 AM Central Daylight Time	08/03/2018 09:40:02 AM Central Daylight Time	07/31/2018 06:02:54 PM Central Daylight Time			08/06/2018 09:07:56 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H1278	005	0	2019	San Antonio Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1286	002	0	1	01	01	H1286_002_0	3	1				08/02/2018	2019.01	08/02/2018 02:27:30 PM Central Daylight Time	08/03/2018 09:40:41 AM Central Daylight Time	07/31/2018 06:03:16 PM Central Daylight Time			08/06/2018 08:30:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1286	002	0	2019	Spokane County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1286	003	0	1	01	01	H1286_003_0	3	1				07/19/2018	2019.01	07/19/2018 11:46:57 AM Central Daylight Time	07/19/2018 02:18:06 PM Central Daylight Time				07/24/2018 11:45:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H1286	003	0	2019	Spokane County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1286	009	0	1	01	01	H1286_009_0	3	1				07/12/2018	2019.01	07/12/2018 11:45:54 AM Central Daylight Time	08/03/2018 09:42:06 AM Central Daylight Time	07/31/2018 06:03:40 PM Central Daylight Time			08/06/2018 08:30:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1286	009	0	2019	Spokane County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	001	0	1	01	01	H1290_001_0	7	1				07/09/2018	2019.01	07/09/2018 09:12:33 AM Eastern Daylight Time	08/03/2018 03:01:15 PM Eastern Daylight Time	08/03/2018 03:34:13 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Miami-Dade (HMO)	01	01		1			H1290	001	0	2019	Miami-Dade County		2	8580	2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	002	0	1	01	01	H1290_002_0	7	1				07/09/2018	2019.01	07/09/2018 09:13:13 AM Eastern Daylight Time	08/03/2018 03:02:14 PM Eastern Daylight Time	08/03/2018 03:35:12 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Broward (HMO)	01	01		1			H1290	002	0	2019	Broward County		2	9642	2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	003	0	1	01	01	H1290_003_0	8	1				07/09/2018	2019.01	07/09/2018 09:14:42 AM Eastern Daylight Time	08/03/2018 03:23:31 PM Eastern Daylight Time	08/03/2018 03:35:54 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Palm Beach (HMO)	01	01		1			H1290	003	0	2019	Palm Beach County		2	4896	2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	004	0	1	01	01	H1290_004_0	7	1				07/09/2018	2019.01	07/09/2018 09:15:05 AM Eastern Daylight Time	08/03/2018 03:24:23 PM Eastern Daylight Time	08/03/2018 03:37:04 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Greater Tampa Bay (HMO)	01	01		1			H1290	004	0	2019	Pinellas, Hillsborough, and Polk Counties		2	16578	2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	005	0	1	01	01	H1290_005_0	7	1				07/09/2018	2019.01	07/09/2018 09:15:28 AM Eastern Daylight Time	08/03/2018 03:25:15 PM Eastern Daylight Time	08/03/2018 03:38:10 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Central Florida (HMO)	01	01		1			H1290	005	0	2019	Osceola and Seminole Counties		2	6882	2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	006	0	1	01	01	H1290_006_0	7	1				08/06/2018	2019.01	08/06/2018 05:10:28 PM Eastern Daylight Time	08/06/2018 03:47:26 PM Eastern Daylight Time	08/03/2018 03:39:32 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Prime Miami-Dade (HMO)	01	01		1			H1290	006	0	2019	Miami-Dade County		2		2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	007	0	1	01	01	H1290_007_0	7	1				08/06/2018	2019.01	08/06/2018 05:10:40 PM Eastern Daylight Time	08/06/2018 03:49:16 PM Eastern Daylight Time	08/03/2018 03:40:31 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Prime Broward (HMO)	01	01		1			H1290	007	0	2019	Broward County		2		2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	008	0	1	01	01	H1290_008_0	7	1				08/06/2018	2019.01	08/06/2018 05:10:56 PM Eastern Daylight Time	08/06/2018 03:51:47 PM Eastern Daylight Time	08/03/2018 03:41:26 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Prime Palm Beach (HMO)	01	01		1			H1290	008	0	2019	Palm Beach County		2		2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	009	0	1	01	01	H1290_009_0	7	1				08/06/2018	2019.01	08/06/2018 05:11:12 PM Eastern Daylight Time	08/06/2018 03:54:13 PM Eastern Daylight Time	08/03/2018 03:42:24 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Prime Greater Tampa Bay (HMO)	01	01		1			H1290	009	0	2019	Pinellas, Hillsborough, and Polk Counties		2		2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	010	0	1	01	01	H1290_010_0	7	1				08/06/2018	2019.01	08/06/2018 05:11:26 PM Eastern Daylight Time	08/06/2018 03:46:07 PM Eastern Daylight Time	08/03/2018 03:43:23 PM Eastern Daylight Time			08/06/2018 05:29:20 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	Devoted.com	Devoted Health Prime Central Florida (HMO)	01	01		1			H1290	010	0	2019	Osceola and Seminole Counties		2		2			2						www.caremark.com	www.caremark.com		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(800)338-6833		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1302	004	0	1	04	01	H1302_004_0	4	2				07/05/2018	2019.01	07/05/2018 11:10:35 AM Mountain Daylight Time	06/01/2018 04:03:01 PM Mountain Daylight Time				07/05/2018 02:26:12 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	Secure Blue no Rx (PPO)	01	04		1			H1302	004	0	2019	Select Counties in Idaho		2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2						2			
H1304	001	0	1	04	01	H1304_001_0	6	1				07/18/2018	2019.01	07/18/2018 02:46:08 PM Mountain Daylight Time	07/19/2018 03:47:44 PM Mountain Daylight Time				07/20/2018 03:58:30 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H1304	001	0	2019	Select Counties in Idaho/Asotin Co, WA		2	4854	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1304	002	0	1	04	01	H1304_002_0	8	1				07/23/2018	2019.01	07/23/2018 09:09:37 AM Mountain Daylight Time	08/01/2018 11:00:43 PM Mountain Daylight Time	08/01/2018 11:01:21 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	002	0	2019	Select Counties in Idaho/Asotin Co, WA		2	35844	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	004	0	1	04	01	H1304_004_0	9	1				07/18/2018	2019.01	07/18/2018 03:26:58 PM Mountain Daylight Time	08/01/2018 11:02:16 PM Mountain Daylight Time	08/01/2018 11:02:55 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H1304	004	0	2019	Select Counties in Idaho/Asotin Co, WA		2	13173	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	008	0	1	04	01	H1304_008_0	7	1				07/20/2018	2019.01	07/20/2018 02:11:03 PM Mountain Daylight Time	07/19/2018 06:47:25 PM Mountain Daylight Time				07/20/2018 03:58:30 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H1304	008	0	2019	Ada, Boise, Canyon, Gem, and Owyhee counties		2	1320	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1304	009	0	1	04	01	H1304_009_0	8	1				07/18/2018	2019.01	07/18/2018 03:50:18 PM Mountain Daylight Time	08/01/2018 11:04:48 PM Mountain Daylight Time	08/01/2018 11:05:26 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	009	0	2019	Ada, Boise, Canyon, Gem, and Owyhee counties		2	7602	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	010	0	1	04	01	H1304_010_0	9	1				07/20/2018	2019.01	07/20/2018 02:11:15 PM Mountain Daylight Time	08/01/2018 11:06:16 PM Mountain Daylight Time	08/01/2018 11:06:55 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H1304	010	0	2019	Ada, Boise, Canyon, Gem, and Owyhee counties		2	3048	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	803	0	1	04	01	H1304_803_0	1	1				06/05/2018	2019.01	06/05/2018 09:27:01 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H1304	803	0	2019	Nationwide except territories		1	27810	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1304	804	0	1	04	01	H1304_804_0	1	1				05/18/2018	2019.01	05/18/2018 11:08:36 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H1304	804	0	2019	Nationwide except territories		1	5464	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1304	805	0	1	04	01	H1304_805_0	1	1				06/05/2018	2019.01	06/05/2018 09:29:34 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	01	04		1			H1304	805	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1304	806	0	1	04	01	H1304_806_0	1	1				05/17/2018	2019.01	05/17/2018 04:24:32 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	01	04		1			H1304	806	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1310	001	0	1	20	08	H1310_001_0	1	1				05/23/2018	2019.01	05/23/2018 01:11:33 PM Eastern Daylight Time		05/23/2018 12:54:58 PM Eastern Daylight Time			05/23/2018 01:17:22 PM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	CentraCare	www.mycentracare.com	CentraCare Dual (PACE)	08	20		1			H1310	001	0	2019	Calhoun, Kalamazoo, and VanBuren Counties		2		2			2						mycentracare.com	mycentracare.com										(877)284-4071		(269)441-9300		(877)284-4071		(269)441-9300										(800)649-3777		(269)441-9329		(800)649-3777		(269)441-9329																
H1310	003	0	1	20	08	H1310_003_0	1	1				05/23/2018	2019.01	05/23/2018 01:11:52 PM Eastern Daylight Time		05/23/2018 12:54:55 PM Eastern Daylight Time			05/23/2018 01:17:22 PM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	CentraCare	www.mycentracare.com	CentraCare Medicare-only (PACE)	08	20		1			H1310	003	0	2019	Calhoun, Kalamazoo, and VanBuren Counties		2		2			2						mycentracare.com	mycentracare.com										(877)284-4071		(269)441-9300		(877)284-4071		(269)441-9300										(800)649-3777		(269)441-9329		(800)649-3777		(269)441-9329																
H1350	006	0	1	01	01	H1350_006_0	3	1				07/05/2018	2019.01	07/05/2018 11:11:35 AM Mountain Daylight Time	06/01/2018 04:03:01 PM Mountain Daylight Time				07/05/2018 02:26:12 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue no Rx (HMO)	01	01		1			H1350	006	0	2019	Select Counties in Idaho		2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2					2	2			
H1350	009	0	1	01	01	H1350_009_0	3	1	2	1		06/01/2018	2019.01	06/01/2018 11:45:45 AM Mountain Daylight Time	08/06/2018 10:08:53 AM Mountain Daylight Time	08/06/2018 10:08:53 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	truebluesnp.com	True Blue Special Needs Plan (HMO SNP)	01	01		1			H1350	009	0	2019	Select Counties in Idaho		2		2			1	3		1		2	www.bcidaho.com/SNPpharmacy	www.bcidaho.com/SNPdrugs	www.bcidaho.com/FindAProvider	(888)495-2583		(208)286-3675		(888)495-2583		(208)286-3675		(855)479-3661		(855)479-3661		(888)495-2583		(208)286-3675		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	015	1	1	01	01	H1350_015_1	4	1				07/05/2018	2019.01	07/05/2018 02:16:55 PM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option I (HMO)	01	01		1			H1350	015	1	2019	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	015	2	1	01	01	H1350_015_2	4	1				07/05/2018	2019.01	07/05/2018 11:14:58 AM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option I (HMO)	01	01		1			H1350	015	2	2019	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	016	1	1	01	01	H1350_016_1	4	1				07/05/2018	2019.01	07/05/2018 11:15:50 AM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option II (HMO)	01	01		1			H1350	016	1	2019	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	016	2	1	01	01	H1350_016_2	4	1				07/05/2018	2019.01	07/05/2018 11:16:35 AM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time	08/06/2018 10:08:54 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option II (HMO)	01	01		1			H1350	016	2	2019	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	019	1	1	01	01	H1350_019_1	4	1				07/05/2018	2019.01	07/05/2018 11:17:36 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx (HMO)	01	01		1			H1350	019	1	2019	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	019	2	1	01	01	H1350_019_2	4	1				07/05/2018	2019.01	07/05/2018 11:18:21 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx (HMO)	01	01		1			H1350	019	2	2019	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	021	0	1	01	01	H1350_021_0	5	1				07/05/2018	2019.01	07/05/2018 11:19:24 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Preferred (HMO)	01	01		1			H1350	021	0	2019	Ada and Canyon counties		2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	1	01	4b;7a;8a2;8b3;	
H1350	022	1	1	01	01	H1350_022_1	5	1				07/05/2018	2019.01	07/05/2018 11:20:17 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time	08/06/2018 10:08:55 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Gem (HMO)	01	01		1			H1350	022	1	2019	Select Counties in Idaho	Select Counties 1 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	022	2	1	01	01	H1350_022_2	5	1				07/05/2018	2019.01	07/05/2018 11:21:11 AM Mountain Daylight Time	08/06/2018 10:08:56 AM Mountain Daylight Time	08/06/2018 10:08:56 AM Mountain Daylight Time			08/06/2018 10:15:53 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Gem (HMO)	01	01		1			H1350	022	2	2019	Select Counties in Idaho	Select Counties 2 Idaho	2		2			2						www.bcidaho.com/FindAPharmacy	www.bcidaho.com/DrugList	www.bcidaho.com/FindAProvider	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1352	001	0	1	01	01	H1352_001_0	3	1				08/05/2018	2019.01	08/05/2018 10:10:28 PM Central Daylight Time	08/06/2018 04:44:23 PM Central Daylight Time	08/06/2018 04:44:23 PM Central Daylight Time			08/06/2018 04:50:25 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Complete (HMO)	01	01		1			H1352	001	0	2019	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	002	0	1	01	01	H1352_002_0	3	1				08/05/2018	2019.01	08/05/2018 10:14:46 PM Central Daylight Time	08/06/2018 04:44:24 PM Central Daylight Time	08/06/2018 04:44:25 PM Central Daylight Time			08/06/2018 04:50:25 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Plus (HMO)	01	01		1			H1352	002	0	2019	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	801	0	1	01	01	H1352_801_0	1	1				06/01/2018	2019.01	06/01/2018 03:33:07 PM Central Daylight Time					06/01/2018 04:46:03 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group Plan MA-CY (HMO)	01	01		1			H1352	801	0	2019	Kansas City Area		1	13200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7b;7e;7g;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1					1				
H1352	803	0	1	01	01	H1352_803_0	1	1				06/01/2018	2019.01	06/01/2018 02:13:22 PM Central Daylight Time					06/01/2018 04:46:03 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group Plan MAPDCY (HMO)	01	01		1			H1352	803	0	2019	Kansas City Area		1	6000	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;5;7b;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1				
H1352	804	0	1	01	01	H1352_804_0	1	1				06/01/2018	2019.01	06/01/2018 02:14:03 PM Central Daylight Time					06/01/2018 04:46:03 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group Plan MAPDBY (HMO)	01	01		1			H1352	804	0	2019	Kansas City Area		1	1200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;5;7b;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1				
H1357	001	0	1	20	08	H1357_001_0	4	1				06/01/2018	2019.01	06/01/2018 03:49:49 PM Eastern Daylight Time		06/04/2018 01:00:08 PM Eastern Daylight Time			06/04/2018 01:40:28 PM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	001	0	2019	Carolina SeniorCare		2		2			2						https://www.carolinaseniorcare.org/	https://www.carolinaseniorcare.org/										(833)223-4476		(336)746-3500		(833)223-4476		(336)746-3500										(883)223-4476		(336)746-3500		(833)223-4476		(336)746-3500																
H1357	002	0	1	20	08	H1357_002_0	4	1				06/01/2018	2019.01	06/01/2018 03:50:26 PM Eastern Daylight Time		06/04/2018 01:00:04 PM Eastern Daylight Time			06/04/2018 01:40:28 PM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	002	0	2019	Carolina SeniorCare		2		2			2						https://www.carolinaseniorcare.org/	https://www.carolinaseniorcare.org/										(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500										(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500																
H1365	001	0	1	04	01	H1365_001_0	8	1				07/23/2018	2019.01	07/23/2018 05:55:14 PM Eastern Daylight Time	08/07/2018 03:04:50 PM Eastern Daylight Time	08/07/2018 12:44:34 PM Eastern Daylight Time			08/07/2018 06:48:47 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	001	0	2019	Southern Maine & Southern New Hampshire		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	002	0	1	04	01	H1365_002_0	7	1				07/16/2018	2019.01	07/16/2018 05:30:15 PM Eastern Daylight Time	08/07/2018 12:44:23 PM Eastern Daylight Time	08/07/2018 12:44:33 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	002	0	2019	Northern Maine & Northern New Hampshire		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	802	0	1	04	01	H1365_802_0	4	1				04/16/2018	2019.01	04/16/2018 05:10:40 PM Eastern Daylight Time					06/04/2018 09:04:06 AM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	802	0	2019	National		1	0	2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	803	0	1	04	01	H1365_803_0	4	1				04/16/2018	2019.01	04/16/2018 04:37:29 PM Eastern Daylight Time					06/04/2018 09:04:06 AM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	803	0	2019	National		1	0	2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1372	001	0	1	01	01	H1372_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:09:24 AM Eastern Daylight Time	08/07/2018 02:52:00 PM Eastern Daylight Time	08/07/2018 02:52:00 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	MARQUIS ADVANTAGE, INC.	AgeRight Advantage Health Plan (HMO SNP)	www.agerightadvantage.com	AgeRight Advantage Health Plan (HMO SNP)	01	01		1			H1372	001	0	2019	OR Counties: CLK, KLA, LAN, MUL, WSH & YAM		2	4686	2			1	1	3				www.agerightadvantage.com	www.agerightadvantage.com	www.agerightadvantage.com	(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1393	001	0	1	04	01	H1393_001_0	11	1				07/06/2018	2019.01	07/06/2018 12:45:31 PM Central Daylight Time	08/02/2018 01:19:56 PM Central Daylight Time	08/02/2018 11:04:10 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Flex (PPO)	01	04		1			H1393	001	0	2019	Davidson, Rutherford, and Williamson Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1393	002	0	1	04	01	H1393_002_0	11	1				07/06/2018	2019.01	07/06/2018 12:45:39 PM Central Daylight Time	08/02/2018 01:20:54 PM Central Daylight Time	08/02/2018 11:04:50 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Flex Plus (PPO)	01	04		1			H1393	002	0	2019	Davidson, Rutherford, and Williamson Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1415	013	0	1	01	01	H1415_013_0	3	1				07/20/2018	2019.01	07/20/2018 03:44:02 PM Central Daylight Time	07/16/2018 02:06:10 PM Central Daylight Time				07/21/2018 05:50:30 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H1415	013	0	2019	Cook, DuPage, Kane, and Will		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1415	021	0	1	02	01	H1415_021_0	4	1				08/02/2018	2019.01	08/02/2018 11:32:37 AM Central Daylight Time	08/03/2018 11:07:53 AM Central Daylight Time	07/31/2018 08:13:53 PM Central Daylight Time			08/06/2018 11:21:47 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H1415	021	0	2019	Cook, DuPage, Kane, and Will		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1415	024	0	1	01	01	H1415_024_0	4	1				07/20/2018	2019.01	07/20/2018 03:44:26 PM Central Daylight Time	08/03/2018 11:08:17 AM Central Daylight Time	07/31/2018 08:14:07 PM Central Daylight Time			08/06/2018 11:21:47 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H1415	024	0	2019	Cook, DuPage, Kane, and Will		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	009	0	1	02	01	H1416_009_0	3	1				08/03/2018	2019.01	08/03/2018 12:28:59 PM Eastern Daylight Time	08/06/2018 04:51:43 PM Eastern Daylight Time	08/01/2018 02:20:34 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1416	009	0	2019	Select Counties in IL		2	91089	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	023	0	1	01	01	H1416_023_0	3	1				05/29/2018	2019.01	05/29/2018 06:34:17 PM Eastern Daylight Time	08/06/2018 04:52:25 PM Eastern Daylight Time	08/01/2018 02:20:55 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H1416	023	0	2019	Select Counties in IL		2	44267	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	024	0	1	02	01	H1416_024_0	3	1				08/03/2018	2019.01	08/03/2018 12:28:12 PM Eastern Daylight Time	08/06/2018 04:53:10 PM Eastern Daylight Time	08/01/2018 02:21:16 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO-POS)	01	02		1			H1416	024	0	2019	Select Counties in IL		2	4729	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	026	0	1	02	01	H1416_026_0	3	1				08/03/2018	2019.01	08/03/2018 12:27:34 PM Eastern Daylight Time	08/06/2018 04:53:54 PM Eastern Daylight Time	08/01/2018 02:21:38 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H1416	026	0	2019	Select Counties in MS		2	60804	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	031	0	1	02	01	H1416_031_0	3	1				08/03/2018	2019.01	08/03/2018 12:26:03 PM Eastern Daylight Time	08/06/2018 04:54:39 PM Eastern Daylight Time	08/01/2018 02:21:59 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1416	031	0	2019	Select Counties in TN		2	19829	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	032	0	1	02	01	H1416_032_0	3	1				08/03/2018	2019.01	08/03/2018 12:25:23 PM Eastern Daylight Time	08/06/2018 04:55:23 PM Eastern Daylight Time	08/01/2018 02:22:20 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1416	032	0	2019	Select Counties in AR		2	41788	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	033	0	1	01	01	H1416_033_0	3	1	2	1		05/22/2018	2019.01	05/22/2018 06:25:39 AM Eastern Daylight Time	08/06/2018 04:56:13 PM Eastern Daylight Time	08/01/2018 02:22:41 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1416	033	0	2019	Select Counties in AR		2	49937	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	034	0	1	01	01	H1416_034_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 05:47:17 PM Eastern Daylight Time	08/06/2018 04:56:57 PM Eastern Daylight Time	08/01/2018 02:23:03 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1416	034	0	2019	Select Counties in MS		2	132696	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	035	0	1	01	01	H1416_035_0	3	1	2	1		05/22/2018	2019.01	05/22/2018 06:54:39 AM Eastern Daylight Time	08/06/2018 04:57:42 PM Eastern Daylight Time	08/01/2018 02:23:24 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1416	035	0	2019	Select Counties in TN		2	54062	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	036	0	1	01	01	H1416_036_0	4	1	2	1		07/13/2018	2019.01	07/13/2018 09:11:30 AM Eastern Daylight Time	08/06/2018 04:58:29 PM Eastern Daylight Time	08/01/2018 02:23:45 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1416	036	0	2019	Select Counties in SC		2	42220	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	038	0	1	01	01	H1416_038_0	3	1				08/03/2018	2019.01	08/03/2018 12:31:53 PM Eastern Daylight Time	08/06/2018 04:59:12 PM Eastern Daylight Time	08/01/2018 02:24:07 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1416	038	0	2019	Select Counties in MS		2	141786	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	039	0	1	01	01	H1416_039_0	3	1				08/03/2018	2019.01	08/03/2018 04:40:54 PM Eastern Daylight Time	08/06/2018 04:59:56 PM Eastern Daylight Time	08/01/2018 02:24:28 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1416	039	0	2019	Select Counties in TN		2	38356	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	041	0	1	01	01	H1416_041_0	3	1				05/22/2018	2019.01	05/22/2018 07:04:19 AM Eastern Daylight Time	08/06/2018 05:00:41 PM Eastern Daylight Time	08/01/2018 02:24:50 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H1416	041	0	2019	Select Counties in AR		2	83324	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	042	0	1	01	01	H1416_042_0	3	1				05/22/2018	2019.01	05/22/2018 07:10:08 AM Eastern Daylight Time	08/06/2018 05:01:27 PM Eastern Daylight Time	08/01/2018 02:25:11 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H1416	042	0	2019	Select Counties in TN		2	28291	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	043	0	1	01	01	H1416_043_0	3	1	2	1		05/22/2018	2019.01	05/22/2018 07:15:13 AM Eastern Daylight Time	08/06/2018 05:02:11 PM Eastern Daylight Time	08/01/2018 02:25:32 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H1416	043	0	2019	Select Counties in AR		2	22427	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	044	0	1	01	01	H1416_044_0	3	1	2	1		08/03/2018	2019.01	08/03/2018 12:33:43 PM Eastern Daylight Time	08/06/2018 05:02:56 PM Eastern Daylight Time	08/01/2018 02:25:53 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H1416	044	0	2019	Select Counties in MS		2	28835	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	048	0	1	01	01	H1416_048_0	3	1				05/30/2018	2019.01	05/30/2018 05:27:27 PM Eastern Daylight Time	08/06/2018 05:03:41 PM Eastern Daylight Time	08/01/2018 02:26:15 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	01	01		1			H1416	048	0	2019	Select Counties in IL		2	68117	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	052	1	1	01	01	H1416_052_1	3	1				08/03/2018	2019.01	08/03/2018 03:56:22 PM Eastern Daylight Time	08/06/2018 05:04:26 PM Eastern Daylight Time	08/01/2018 02:26:36 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1416	052	1	2019	Select Counties in South Carolina	Select Counties in South Carolina	2	74840	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	052	2	1	01	01	H1416_052_2	4	1				08/03/2018	2019.01	08/03/2018 03:55:16 PM Eastern Daylight Time	08/06/2018 05:05:10 PM Eastern Daylight Time	08/01/2018 02:26:57 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1416	052	2	2019	Select Counties in South Carolina	Select Counties in South Carolina	2	16760	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	053	0	1	02	01	H1416_053_0	2	1				05/18/2018	2019.01	05/18/2018 02:23:10 PM Eastern Daylight Time	06/02/2018 02:18:11 AM Eastern Daylight Time				06/02/2018 10:07:17 AM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	01	02		1			H1416	053	0	2019	Select Counties in IL		2	893	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fap_search	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	054	1	1	02	01	H1416_054_1	2	1				05/18/2018	2019.01	05/18/2018 01:10:49 PM Eastern Daylight Time	06/02/2018 02:19:11 AM Eastern Daylight Time				06/02/2018 10:07:17 AM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	01	02		1			H1416	054	1	2019	Selected Counties in AR, TN, MS and SC	Selected Counties in AR, MS and TN	2	16738	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fap_search	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	054	2	1	02	01	H1416_054_2	2	1				05/18/2018	2019.01	05/18/2018 06:56:58 PM Eastern Daylight Time	06/02/2018 02:20:09 AM Eastern Daylight Time				06/02/2018 10:07:17 AM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	01	02		1			H1416	054	2	2019	Selected Counties in AR, TN, MS and SC	Selected Counties in SC	2	4278	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fap_search	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	055	0	1	01	01	H1416_055_0	3	1				08/03/2018	2019.01	08/03/2018 12:29:48 PM Eastern Daylight Time	08/06/2018 05:08:07 PM Eastern Daylight Time	08/01/2018 02:27:19 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	WellCare	www.wellcare.com/medicare	WellCare Preferred (HMO)	01	01		1			H1416	055	0	2019	Selected Counties in AR		2	6149	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fap_search	(800)316-2273		(800)316-2273		(800)316-2273		(800)316-2273		(800)316-2273		(800)316-2273		(800)316-2273		(800)316-2273		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	001	0	1	01	01	H1426_001_0	5	1				08/04/2018	2019.01	08/04/2018 07:24:54 AM Pacific Daylight Time	08/04/2018 09:18:47 PM Pacific Daylight Time	08/04/2018 09:20:20 PM Pacific Daylight Time			08/05/2018 10:34:44 AM Pacific Daylight Time	VITALITY HEALTH PLAN OF CALIFORNIA, INC.	Vitality Health Plan of California	www.VitalityHP.net	Vitality Choice (HMO)	01	01		1			H1426	001	0	2019	San Joaquin County		2		2			2						www.VitalityHP.net	www.VitalityHP.net	www.VitalityHP.net			(866)333-3530				(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	002	0	1	01	01	H1426_002_0	5	1				08/04/2018	2019.01	08/04/2018 07:25:05 AM Pacific Daylight Time	08/04/2018 09:18:51 PM Pacific Daylight Time	08/04/2018 09:20:23 PM Pacific Daylight Time			08/05/2018 10:34:44 AM Pacific Daylight Time	VITALITY HEALTH PLAN OF CALIFORNIA, INC.	Vitality Health Plan of California	www.VitalityHP.net	Vitality Choice (HMO)	01	01		1			H1426	002	0	2019	Santa Clara County		2		2			2						www.VitalityHP.net	www.VitalityHP.net	www.VitalityHP.net			(866)333-3530				(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	003	0	1	01	01	H1426_003_0	5	1				08/03/2018	2019.01	08/03/2018 09:34:20 AM Pacific Daylight Time	08/04/2018 09:18:56 PM Pacific Daylight Time	08/04/2018 09:20:25 PM Pacific Daylight Time			08/05/2018 10:34:44 AM Pacific Daylight Time	VITALITY HEALTH PLAN OF CALIFORNIA, INC.	Vitality Health Plan of California	www.VitalityHP.net	Vitality Plus (HMO)	01	01		1			H1426	003	0	2019	San Joaquin and Santa Clara counties		2		2			2						www.VitalityHP.net	www.VitalityHP.net	www.VitalityHP.net			(866)333-3530				(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	001	0	1	01	01	H1436_001_0	6	1				08/02/2018	2019.01	08/02/2018 08:30:59 AM Eastern Daylight Time	08/04/2018 08:36:34 AM Eastern Daylight Time	08/04/2018 08:36:34 AM Eastern Daylight Time			08/04/2018 09:30:26 AM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Medicare (HMO)	01	01		1			H1436	001	0	2019	Abbeville, Chesterfield, Georgetown, Beaufort		2		2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	002	0	1	01	01	H1436_002_0	6	1				08/02/2018	2019.01	08/02/2018 08:31:33 AM Eastern Daylight Time	08/04/2018 08:36:36 AM Eastern Daylight Time	08/04/2018 08:36:37 AM Eastern Daylight Time			08/04/2018 09:30:26 AM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Medicare (HMO)	01	01		1			H1436	002	0	2019	Greater Charleston Area		2		2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	003	0	1	01	01	H1436_003_0	6	1				08/02/2018	2019.01	08/02/2018 08:32:01 AM Eastern Daylight Time	08/04/2018 08:36:38 AM Eastern Daylight Time	08/04/2018 08:36:39 AM Eastern Daylight Time			08/04/2018 09:30:26 AM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Medicare (HMO)	01	01		1			H1436	003	0	2019	Greater Richland Area		2		2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	004	0	1	01	01	H1436_004_0	6	1				08/02/2018	2019.01	08/02/2018 08:32:30 AM Eastern Daylight Time	08/04/2018 08:37:54 AM Eastern Daylight Time	08/04/2018 08:37:54 AM Eastern Daylight Time			08/04/2018 09:30:26 AM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Medicare (HMO)	01	01		1			H1436	004	0	2019	Greater Greenville Area		2		2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	005	0	1	01	01	H1436_005_0	6	1	2	1		08/02/2018	2019.01	08/02/2018 08:33:42 AM Eastern Daylight Time	08/04/2018 08:37:56 AM Eastern Daylight Time	08/04/2018 08:37:57 AM Eastern Daylight Time			08/04/2018 09:30:26 AM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H1436	005	0	2019	Statewide		2		2			1	3		1		1	allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	006	0	1	01	01	H1436_006_0	6	1	2	1		08/02/2018	2019.01	08/02/2018 06:05:24 PM Eastern Daylight Time	08/04/2018 08:37:58 AM Eastern Daylight Time	08/04/2018 08:37:59 AM Eastern Daylight Time			08/04/2018 09:30:26 AM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Dual Medicare Essentials (HMO SNP)	01	01		1			H1436	006	0	2019	Statewide		2		2			1	3		2		2	allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	801	0	1	01	01	H1436_801_0	2	1				05/29/2018	2019.01	05/29/2018 04:07:04 PM Pacific Daylight Time					06/03/2018 02:33:16 PM Pacific Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	01	01		1			H1436	801	0	2019	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/find-doctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1436	802	0	1	01	01	H1436_802_0	2	1				05/29/2018	2019.01	05/29/2018 05:27:23 PM Pacific Daylight Time					06/03/2018 02:33:16 PM Pacific Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	01	01		1			H1436	802	0	2019	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/find-doctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1436	803	0	1	01	01	H1436_803_0	2	1				05/29/2018	2019.01	05/29/2018 04:07:18 PM Pacific Daylight Time					06/03/2018 02:33:16 PM Pacific Daylight Time	ABSOLUTE TOTAL CARE, INC.	Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	01	01		1			H1436	803	0	2019	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/find-doctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1463	003	0	1	01	01	H1463_003_0	12	1				07/30/2018	2019.01	07/30/2018 09:46:10 AM Central Daylight Time	08/03/2018 01:55:23 PM Central Daylight Time	08/03/2018 01:37:15 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO 20 Rx (HMO)	01	01		1			H1463	003	0	2019	North Central, Central, Southern, & Quad Cities		2	57947	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	008	0	1	01	01	H1463_008_0	12	1				07/26/2018	2019.01	07/26/2018 08:36:01 AM Central Daylight Time	07/09/2018 10:40:40 AM Central Daylight Time				07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic (HMO)	01	01		1			H1463	008	0	2019	North Central, Central, Southern, & Quad Cities		2	11991	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	009	0	1	01	01	H1463_009_0	12	1				07/26/2018	2019.01	07/26/2018 08:36:12 AM Central Daylight Time	08/03/2018 02:01:30 PM Central Daylight Time	08/03/2018 01:37:45 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic Rx (HMO)	01	01		1			H1463	009	0	2019	North Central, Central, Southern, & Quad Cities		2	38694	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	010	0	1	01	01	H1463_010_0	12	1				07/26/2018	2019.01	07/26/2018 08:36:24 AM Central Daylight Time	08/03/2018 02:05:42 PM Central Daylight Time	08/03/2018 01:38:18 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO 40 Rx (HMO)	01	01		1			H1463	010	0	2019	North Central, Central, Southern, & Quad Cities		2	36782	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	012	0	1	01	01	H1463_012_0	12	1				07/26/2018	2019.01	07/26/2018 08:36:38 AM Central Daylight Time	08/03/2018 02:09:01 PM Central Daylight Time	08/06/2018 09:45:33 AM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO Rx Plus (HMO)	01	01		1			H1463	012	0	2019	East Central IN and Western OH		2	551	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	013	0	1	01	01	H1463_013_0	12	1				07/26/2018	2019.01	07/26/2018 08:36:53 AM Central Daylight Time	08/03/2018 02:12:13 PM Central Daylight Time	08/03/2018 01:41:28 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO Rx (HMO)	01	01		1			H1463	013	0	2019	East Central IN and Western OH		2	6317	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	014	0	1	02	01	H1463_014_0	12	1				07/26/2018	2019.01	07/26/2018 09:05:29 AM Central Daylight Time	07/09/2018 10:41:48 AM Central Daylight Time				07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare POS Basic (HMO-POS)	01	02		1			H1463	014	0	2019	North Central, Central, Southern, & Quad Cities		2	2591	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	015	0	1	02	01	H1463_015_0	12	1				07/26/2018	2019.01	07/26/2018 09:06:02 AM Central Daylight Time	08/03/2018 02:17:45 PM Central Daylight Time	08/03/2018 01:45:04 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare POS Basic Rx (HMO-POS)	01	02		1			H1463	015	0	2019	North Central, Central, Southern, & Quad Cities		2	7165	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	017	0	1	02	01	H1463_017_0	12	1				07/26/2018	2019.01	07/26/2018 09:06:44 AM Central Daylight Time	08/03/2018 02:22:08 PM Central Daylight Time	08/03/2018 01:45:40 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare POS 30 Rx (HMO-POS)	01	02		1			H1463	017	0	2019	North Central, Central, Southern, & Quad Cities		2	17199	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	019	0	1	02	01	H1463_019_0	12	1				07/30/2018	2019.01	07/30/2018 10:02:41 AM Central Daylight Time	08/03/2018 02:25:45 PM Central Daylight Time	08/06/2018 10:10:34 AM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare POS 10 Rx (HMO-POS)	01	02		1			H1463	019	0	2019	North Central, Central, Southern, & Quad Cities		2	36645	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	020	0	1	01	01	H1463_020_0	10	1				07/26/2018	2019.01	07/26/2018 08:38:08 AM Central Daylight Time	06/02/2018 04:13:26 AM Central Daylight Time				07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO (HMO)	01	01		1			H1463	020	0	2019	East Central IN and Western OH		2	532	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	021	0	1	01	01	H1463_021_0	12	1				08/02/2018	2019.01	08/02/2018 01:44:15 PM Central Daylight Time	08/03/2018 04:10:06 PM Central Daylight Time	08/03/2018 01:46:53 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Guide HMO Rx 2 (HMO)	01	01		1			H1463	021	0	2019	Whiteside, Henry, Mercer, and Rock Island Counties		2	815	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(877)933-8454		(877)933-8454		(800)965-4022		(800)965-4022		(877)933-8454		(877)933-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	022	0	1	02	01	H1463_022_0	12	1				07/26/2018	2019.01	07/26/2018 09:07:41 AM Central Daylight Time	08/03/2018 02:29:40 PM Central Daylight Time	08/03/2018 01:47:45 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Reid Heath Alliance Medicare POS Rx (HMO-POS)	01	02		1			H1463	022	0	2019	East Central IN		2	4266	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	023	0	1	01	01	H1463_023_0	12	1				07/26/2018	2019.01	07/26/2018 08:39:52 AM Central Daylight Time	08/03/2018 02:33:00 PM Central Daylight Time	08/03/2018 01:48:38 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Simplete 1 (HMO)	01	01		1			H1463	023	0	2019	Eastern and Central IL		2	2342	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	024	0	1	01	01	H1463_024_0	12	1				07/26/2018	2019.01	07/26/2018 08:40:09 AM Central Daylight Time	08/03/2018 02:36:11 PM Central Daylight Time	08/03/2018 01:49:58 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Simplete 2 (HMO)	01	01		1			H1463	024	0	2019	Eastern and Central IL		2	1565	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7b;7d;8a1;8a2;8b1;8b2;8b3;9a1;17a;	
H1463	025	0	1	02	01	H1463_025_0	11	1				07/26/2018	2019.01	07/26/2018 09:08:06 AM Central Daylight Time	08/03/2018 04:06:49 PM Central Daylight Time	08/03/2018 01:50:51 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Simplete 3 (HMO-POS)	01	02		1			H1463	025	0	2019	Eastern and Central IL		2	1043	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7a;7b;7d;8a1;8a2;8b1;8b2;8b3;9a1;9b;9c;17a;	17a1;
H1463	032	0	1	01	01	H1463_032_0	12	1				08/03/2018	2019.01	08/03/2018 12:12:12 PM Central Daylight Time	08/03/2018 04:14:04 PM Central Daylight Time	08/03/2018 01:51:34 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Simplete Riverside 1 (HMO)	01	01		1			H1463	032	0	2019	Kankakee and Iroquois Counties		2	3891	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	033	0	1	01	01	H1463_033_0	12	1				07/26/2018	2019.01	07/26/2018 08:40:52 AM Central Daylight Time	08/03/2018 03:03:12 PM Central Daylight Time	08/03/2018 01:54:08 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Simplete Riverside 2 (HMO)	01	01		1			H1463	033	0	2019	Greater Kankakee Area of NE IL/NW IN		2	2303	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7b;7d;8a1;8a2;8b1;8b2;8b3;9a1;17a;	
H1463	034	0	1	02	01	H1463_034_0	12	1				07/26/2018	2019.01	07/26/2018 11:30:58 AM Central Daylight Time	08/03/2018 03:21:58 PM Central Daylight Time	08/03/2018 01:55:01 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	healthalliancemedicare.org	Simplete Riverside 3 (HMO-POS)	01	02		1			H1463	034	0	2019	Greater Kankakee Area of NE IL/NW IN		2	1535	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7b;7d;8a1;8a2;8b1;8b2;8b3;9a1;9b;9c;17a;	
H1463	801	0	1	01	01	H1463_801_0	3	1				06/05/2018	2019.01	06/05/2018 09:30:59 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1463	801	0	2019	Illinois		1	1800	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H1463	802	0	1	01	01	H1463_802_0	3	1				06/05/2018	2019.01	06/05/2018 09:31:17 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1463	802	0	2019	Illinois		1	19200	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1463	810	0	1	01	01	H1463_810_0	3	1				06/05/2018	2019.01	06/05/2018 09:31:24 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	01	01		1			H1463	810	0	2019	Illinois		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1463	811	0	1	02	01	H1463_811_0	3	1				06/05/2018	2019.01	06/05/2018 09:31:31 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS (HMO-POS)	01	02		1			H1463	811	0	2019	Illinois		1	1020	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										1	2		2		1	2		2		1				
H1463	812	0	1	02	01	H1463_812_0	3	1				06/05/2018	2019.01	06/05/2018 09:31:39 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	01	02		1			H1463	812	0	2019	Illinois		1	7200	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H1463	813	0	1	02	01	H1463_813_0	3	1				06/05/2018	2019.01	06/05/2018 09:31:45 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	01	02		1			H1463	813	0	2019	Illinois		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H1468	007	0	1	01	01	H1468_007_0	5	1				07/02/2018	2019.01	07/02/2018 04:45:42 PM Eastern Daylight Time	07/18/2018 02:55:53 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1468-007 (HMO)	01	01		1			H1468	007	0	2019	Peoria and Rockford Illinois Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	013	0	1	01	01	H1468_013_0	5	1				07/02/2018	2019.01	07/02/2018 04:46:50 PM Eastern Daylight Time	07/18/2018 02:56:49 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1468-013 (HMO)	01	01		1			H1468	013	0	2019	Cook, Lake and Will counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	014	0	1	01	01	H1468_014_0	5	1				07/02/2018	2019.01	07/02/2018 04:47:51 PM Eastern Daylight Time	07/18/2018 02:59:39 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1468-014 (HMO)	01	01		1			H1468	014	0	2019	Kane, Kendall and McHenry counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	016	0	1	01	01	H1468_016_0	5	1				07/02/2018	2019.01	07/02/2018 04:49:06 PM Eastern Daylight Time	08/03/2018 06:32:25 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1468-016 (HMO)	01	01		1			H1468	016	0	2019	DuPage County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	017	0	1	01	01	H1468_017_0	7	1		1		07/02/2018	2019.01	07/02/2018 04:50:13 PM Eastern Daylight Time	07/18/2018 03:07:37 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Community HMO Diabetes and Heart (HMO SNP)	01	01		1			H1468	017	0	2019	Cook, DuPage and Will counties		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	802	0	1	01	01	H1468_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:23:39 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	802	0	2019	Select counties in Peoria Metro area		1	79927	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1468	803	0	1	01	01	H1468_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:24:00 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	803	0	2019	Select counties in Peoria Metro area		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1475	001	0	1	01	01	H1475_001_0	6	1				08/03/2018	2019.01	08/03/2018 08:21:48 AM Eastern Daylight Time	08/04/2018 08:38:02 AM Eastern Daylight Time	08/04/2018 08:38:04 AM Eastern Daylight Time			08/04/2018 09:11:15 AM Eastern Daylight Time	ILLINICARE HEALTH PLAN	Illinicare Health	allwell.illinicare.com	Allwell Medicare (HMO)	01	01		1			H1475	001	0	2019	Northeast Illinois		2		2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1475	002	0	1	01	01	H1475_002_0	7	1				08/03/2018	2019.01	08/03/2018 08:22:08 AM Eastern Daylight Time	08/04/2018 08:51:06 AM Eastern Daylight Time	08/04/2018 08:51:08 AM Eastern Daylight Time			08/04/2018 09:11:15 AM Eastern Daylight Time	ILLINICARE HEALTH PLAN	Illinicare Health	allwell.illinicare.com	Allwell Medicare (HMO)	01	01		1			H1475	002	0	2019	Kane county		2		2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1475	801	0	1	01	01	H1475_801_0	3	1				05/29/2018	2019.01	05/29/2018 04:07:38 PM Pacific Daylight Time					06/04/2018 03:55:19 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	Illinicare Health	allwell.illinicare.com	Allwell Group (HMO)	01	01		1			H1475	801	0	2019	Illinois		1	100	2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1475	802	0	1	01	01	H1475_802_0	3	1				05/29/2018	2019.01	05/29/2018 04:07:45 PM Pacific Daylight Time					06/04/2018 03:55:19 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	Illinicare Health	allwell.illinicare.com	Allwell Group (HMO)	01	01		1			H1475	802	0	2019	Illinois		1	100	2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1475	803	0	1	01	01	H1475_803_0	3	1				05/29/2018	2019.01	05/29/2018 05:27:28 PM Pacific Daylight Time					06/04/2018 03:55:19 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	Illinicare Health	allwell.illinicare.com	Allwell Group (HMO)	01	01		1			H1475	803	0	2019	Illinois		1	100	2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1500	001	0	1	20	08	H1500_001_0	1	1				05/23/2018	2019.01	05/23/2018 01:11:34 PM Eastern Daylight Time		05/21/2018 10:27:22 AM Eastern Daylight Time			05/23/2018 01:16:14 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	www.sjp.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	001	0	2019	LIFE St. Joseph of the Pines		2		2			2						www.sjp.org	www.sjp.org												(910)483-4911		(910)483-4911		(910)483-4911										(877)452-2514		(877)452-2514		(877)452-2514		(877)452-2514																
H1500	002	0	1	20	08	H1500_002_0	1	1				05/23/2018	2019.01	05/23/2018 01:11:52 PM Eastern Daylight Time		05/21/2018 10:27:22 AM Eastern Daylight Time			05/23/2018 01:16:14 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	www.sjp.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	002	0	2019	LIFE St. Joseph of the Pines		2		2			2						www.sjp.org	www.sjp.org										(910)483-4911		(910)483-4911		(910)483-4911		(910)483-4911										(877)452-2514		(877)452-2514		(877)452-2514		(877)452-2514																
H1518	001	0	1	20	08	H1518_001_0	1	1				05/24/2018	2019.01	05/24/2018 12:46:40 PM Eastern Daylight Time		05/22/2018 09:21:54 AM Eastern Daylight Time			05/24/2018 12:51:13 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	www.chsbuffalo.org/services/seniorservices/LIFE	CHS Buffalo - Dual (PACE)	08	20		1			H1518	001	0	2019	CHS Lackawanna  Erie County		2		2			2						www.chsbuffalo.org	www.chsbuffalo.org										(855)671-3341		(716)819-5433		(855)671-3341		(716)819-5433												(716)819-5227				(716)819-5227																
H1518	002	0	1	20	08	H1518_002_0	1	1				05/24/2018	2019.01	05/24/2018 12:48:27 PM Eastern Daylight Time		05/22/2018 09:22:12 AM Eastern Daylight Time			05/24/2018 12:51:13 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	www.chsbuffalo.org/Services/SeniorServices/LIFE	CHS Buffalo - Medicare only (PACE)	08	20		1			H1518	002	0	2019	CHS Lackawanna Erie County		2		2			2						www.chsbuffalo.org	www.chsbuffalo.org										(855)671-3341		(716)819-5433		(855)671-3341		(716)819-5433												(716)819-5227				(716)819-5227																
H1533	001	0	1	20	08	H1533_001_0	1	1				06/01/2018	2019.01	06/01/2018 05:35:11 PM Eastern Daylight Time		06/01/2018 05:43:36 PM Eastern Daylight Time			06/01/2018 05:45:06 PM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	www.staywellseniorcare.org	StayWell Senior Care - Dual Eligible (PACE)	08	20		1			H1533	001	0	2019	StayWell Senior Care		2		2			2						www.carekinesis.com	www.staywellseniorcare.org										(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200										(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200																
H1533	002	0	1	20	08	H1533_002_0	1	1				06/01/2018	2019.01	06/01/2018 05:35:24 PM Eastern Daylight Time		06/01/2018 05:43:20 PM Eastern Daylight Time			06/01/2018 05:45:06 PM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	www.staywellseniorcare.org	StayWell Senior Care - Medicare Only (PACE)	08	20		1			H1533	002	0	2019	StayWell Senior Care		2		2			2						www.carekinesis.com	www.staywellseniorcare.org										(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200										(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200																
H1537	004	0	1	04	01	H1537_004_0	3	1				07/23/2018	2019.01	07/23/2018 09:56:40 AM Central Daylight Time	08/03/2018 09:42:52 AM Central Daylight Time	07/31/2018 06:04:04 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (PPO)	01	04		1			H1537	004	0	2019	Montgomery county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1537	801	0	1	04	01	H1537_801_0	1	1				05/25/2018	2019.01	05/25/2018 02:43:41 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	801	0	2019	Select Counties		1	25668	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	802	0	1	04	01	H1537_802_0	1	1				05/25/2018	2019.01	05/25/2018 02:34:56 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	802	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H1537	803	0	1	04	01	H1537_803_0	1	1				05/25/2018	2019.01	05/25/2018 02:35:20 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	803	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	804	0	2	04	01	H1537_804_0	1	1				05/25/2018	2019.01	05/25/2018 02:35:39 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	804	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	805	0	2	04	01	H1537_805_0	1	1				05/25/2018	2019.01	05/25/2018 02:36:03 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	805	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H1537	806	0	2	04	01	H1537_806_0	1	1				05/25/2018	2019.01	05/25/2018 02:37:01 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	806	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	807	0	1	04	01	H1537_807_0	1	1				05/25/2018	2019.01	05/25/2018 02:37:33 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	807	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	808	0	1	04	01	H1537_808_0	1	1				05/25/2018	2019.01	05/25/2018 02:38:05 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	808	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H1537	809	0	1	04	01	H1537_809_0	1	1				05/25/2018	2019.01	05/25/2018 02:38:32 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	809	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	816	0	1	04	01	H1537_816_0	1	1				05/25/2018	2019.01	05/25/2018 02:38:49 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	816	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	817	0	1	04	01	H1537_817_0	1	1				05/25/2018	2019.01	05/25/2018 02:39:30 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	817	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	823	0	1	04	01	H1537_823_0	1	1				05/25/2018	2019.01	05/25/2018 02:40:08 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	823	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	824	0	1	04	01	H1537_824_0	1	1				05/25/2018	2019.01	05/25/2018 02:47:55 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	824	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	825	0	1	04	01	H1537_825_0	1	1				05/25/2018	2019.01	05/25/2018 02:49:29 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	825	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H1537	826	0	1	04	01	H1537_826_0	1	1				05/25/2018	2019.01	05/25/2018 02:49:59 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	826	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	827	0	2	04	01	H1537_827_0	1	1				05/25/2018	2019.01	05/25/2018 02:53:15 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	827	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	828	0	2	04	01	H1537_828_0	1	1				05/25/2018	2019.01	05/25/2018 02:55:05 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	828	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H1537	829	0	2	04	01	H1537_829_0	1	1				05/25/2018	2019.01	05/25/2018 02:55:42 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	829	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	830	0	1	04	01	H1537_830_0	1	1				05/25/2018	2019.01	05/25/2018 02:56:30 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	830	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	831	0	1	04	01	H1537_831_0	1	1				05/25/2018	2019.01	05/25/2018 02:58:27 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	831	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	832	0	1	04	01	H1537_832_0	1	1				05/25/2018	2019.01	05/25/2018 03:01:29 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	832	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	833	0	1	04	01	H1537_833_0	1	1				05/25/2018	2019.01	05/25/2018 03:03:13 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	833	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	834	0	1	04	01	H1537_834_0	1	1				05/25/2018	2019.01	05/25/2018 03:04:05 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	834	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-9178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	835	0	2	04	01	H1537_835_0	1	1				05/25/2018	2019.01	05/25/2018 03:05:32 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	835	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	836	0	1	04	01	H1537_836_0	1	1				05/25/2018	2019.01	05/25/2018 03:06:38 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	836	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H1537	837	0	1	04	01	H1537_837_0	1	1				05/25/2018	2019.01	05/25/2018 03:08:45 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	837	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	838	0	1	04	01	H1537_838_0	1	1				05/25/2018	2019.01	05/25/2018 03:09:25 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	838	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	839	0	1	04	01	H1537_839_0	1	1				05/25/2018	2019.01	05/25/2018 03:10:00 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	839	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	840	0	1	04	01	H1537_840_0	1	1				05/25/2018	2019.01	05/25/2018 03:10:45 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	840	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1537	841	0	1	04	01	H1537_841_0	1	1				05/25/2018	2019.01	05/25/2018 03:12:58 PM Central Daylight Time					06/02/2018 12:24:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	841	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H1587	001	0	1	02	01	H1587_001_0	7	1	2	1		07/19/2018	2019.01	07/19/2018 01:22:36 PM Central Daylight Time	08/06/2018 05:08:13 PM Central Daylight Time	08/06/2018 05:08:13 PM Central Daylight Time			08/06/2018 05:08:57 PM Central Daylight Time	ARKANSAS SUPERIOR SELECT, INC.	Superior Select Health Plans	www.superiorselectmedicare.com	Tribute (HMO-POS SNP)	01	02		1			H1587	001	0	2019	Arkansas		2	26880	2			1	3		1		1	www.superiorselectmedicare.com	www.superiorselectmedicare.com	www.superiorselectmedicare.com	(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1587	003	0	1	02	01	H1587_003_0	6	1		1		07/13/2018	2019.01	07/13/2018 05:04:45 PM Central Daylight Time	08/06/2018 05:08:13 PM Central Daylight Time	08/06/2018 05:08:13 PM Central Daylight Time			08/06/2018 05:08:57 PM Central Daylight Time	ARKANSAS SUPERIOR SELECT, INC.	Superior Select Health Plans	www.superiorselectmedicare.com	Select (HMO-POS SNP)	01	02		1			H1587	003	0	2019	Arkansas		2	1116	2			1	1	3				www.superiorselectmedicare.com	www.superiorselectmedicare.com	www.superiorselectmedicare.com	(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1607	012	0	1	04	01	H1607_012_0	7	1				08/03/2018	2019.01	08/03/2018 01:33:33 PM Eastern Daylight Time	08/05/2018 11:31:47 PM Eastern Daylight Time	08/01/2018 07:51:30 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Plus (PPO)	01	04		1			H1607	012	0	2019	Select Counties in Indiana		2	64956	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)558-1438		(855)558-1438		(800)797-6421		(800)797-6421		(855)558-1438		(855)558-1438		(844)364-2110		(844)364-2110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1607	014	0	1	04	01	H1607_014_0	7	1				08/03/2018	2019.01	08/03/2018 01:37:39 PM Eastern Daylight Time	08/05/2018 11:32:46 PM Eastern Daylight Time	08/01/2018 07:52:15 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H1607	014	0	2019	Select Counties in Indiana		2	14208	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)558-1438		(855)558-1438		(800)797-6421		(800)797-6421		(855)558-1438		(855)558-1438		(844)364-2110		(844)364-2110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1607	809	0	1	04	01	H1607_809_0	2	1				06/19/2018	2019.01	06/19/2018 12:54:01 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	809	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1608	001	0	1	04	01	H1608_001_0	4	1			2	08/01/2018	2019.01	08/01/2018 10:34:22 AM Eastern Daylight Time	08/01/2018 03:56:37 PM Eastern Daylight Time	07/31/2018 05:41:28 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Advantra Platinum (PPO)	01	04		1			H1608	001	0	2019	Partial State of Iowa and South Dakota		2	373788	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	004	0	1	04	01	H1608_004_0	3	1			2	08/01/2018	2019.01	08/01/2018 10:35:16 AM Eastern Daylight Time	08/01/2018 03:58:09 PM Eastern Daylight Time	07/31/2018 05:42:08 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Total Care (PPO)	01	04		1			H1608	004	0	2019	Lincoln, McCook, Minnehaha Counties South Dakota		2	12612	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	007	0	1	04	01	H1608_007_0	3	1			2	08/01/2018	2019.01	08/01/2018 10:36:35 AM Eastern Daylight Time	08/01/2018 03:59:42 PM Eastern Daylight Time	07/31/2018 05:42:48 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Total Care (PPO)	01	04		1			H1608	007	0	2019	Marshall and Story Counties Iowa		2	9336	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	008	0	1	04	01	H1608_008_0	3	1			2	08/01/2018	2019.01	08/01/2018 10:37:27 AM Eastern Daylight Time	08/01/2018 04:01:45 PM Eastern Daylight Time	07/31/2018 05:43:27 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Total Care (PPO)	01	04		1			H1608	008	0	2019	Ida, Monona, Plymouth, Woodbury Counties Iowa		2	28512	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	012	0	1	04	01	H1608_012_0	5	1			2	08/01/2018	2019.01	08/01/2018 10:39:54 AM Eastern Daylight Time	08/02/2018 03:08:23 PM Eastern Daylight Time	07/31/2018 05:44:07 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Advantra Platinum (PPO)	01	04		1			H1608	012	0	2019	Partial State of Nebraska		2	48492	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	013	0	1	04	01	H1608_013_0	3	1			2	08/03/2018	2019.01	08/03/2018 04:09:52 PM Central Daylight Time	08/02/2018 01:20:08 PM Central Daylight Time	07/31/2018 09:28:40 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra (PPO)	01	04		1			H1608	013	0	2019	St. Louis Metro		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	016	0	1	04	01	H1608_016_0	3	1			2	08/03/2018	2019.01	08/03/2018 03:50:52 PM Central Daylight Time	08/03/2018 07:14:20 AM Central Daylight Time	07/31/2018 09:29:32 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Freedom (PPO)	01	04		1			H1608	016	0	2019	KC Metro (Kansas & Missouri) Counties		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	017	0	1	04	01	H1608_017_0	3	1			2	08/03/2018	2019.01	08/03/2018 03:54:15 PM Central Daylight Time	08/03/2018 07:15:22 AM Central Daylight Time	07/31/2018 09:30:24 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Medicare Advantage (PPO)	01	04		1			H1608	017	0	2019	Wichita (Kansas) Metro Counties		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	018	0	1	04	01	H1608_018_0	3	1			2	08/03/2018	2019.01	08/03/2018 03:58:36 PM Central Daylight Time	08/03/2018 07:17:30 AM Central Daylight Time	07/31/2018 09:31:14 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Freedom (PPO)	01	04		1			H1608	018	0	2019	South East Kansas & South West Missouri Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	021	0	1	04	01	H1608_021_0	3	1			2	08/03/2018	2019.01	08/03/2018 03:59:44 PM Central Daylight Time	08/03/2018 07:18:31 AM Central Daylight Time	07/31/2018 09:32:06 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Freedom (PPO)	01	04		1			H1608	021	0	2019	Central Oklahoma & North West Arkansas Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	024	0	1	04	01	H1608_024_0	3	1			2	08/02/2018	2019.01	08/02/2018 05:59:12 PM Central Daylight Time	08/03/2018 07:19:25 AM Central Daylight Time	07/31/2018 09:33:00 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Total Care (PPO)	01	04		1			H1608	024	0	2019	North East (Topeka Area) Kansas		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	026	0	1	04	01	H1608_026_0	3	1			2	07/11/2018	2019.01	07/11/2018 10:44:17 AM Eastern Daylight Time	08/02/2018 07:16:14 PM Eastern Daylight Time	07/31/2018 10:57:40 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Gold (PPO)	01	04		1			H1608	026	0	2019	Northern West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	027	0	1	04	01	H1608_027_0	2	1			1	05/29/2018	2019.01	05/29/2018 10:16:45 PM Eastern Daylight Time	08/02/2018 07:17:13 PM Eastern Daylight Time	07/31/2018 10:58:32 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Gold (PPO)	01	04		1			H1608	027	0	2019	Southern West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	028	0	1	04	01	H1608_028_0	3	1			2	05/29/2018	2019.01	05/29/2018 09:55:03 AM Eastern Daylight Time	08/02/2018 11:43:28 AM Eastern Daylight Time	07/31/2018 10:43:58 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Preferred (PPO)	01	04		1			H1608	028	0	2019	Select Georgia Counties		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)613-4977		(866)613-4977		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	029	0	1	04	01	H1608_029_0	2	1			2	08/03/2018	2019.01	08/03/2018 10:13:31 AM Eastern Daylight Time	08/02/2018 02:58:18 PM Eastern Daylight Time	07/31/2018 10:59:24 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (PPO)	01	04		1			H1608	029	0	2019	Northeastern/Youngstown OH Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	031	0	1	04	01	H1608_031_0	2	1			2	08/03/2018	2019.01	08/03/2018 09:29:23 AM Eastern Daylight Time	08/02/2018 07:18:14 PM Eastern Daylight Time	07/31/2018 11:00:18 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	AdvantraOne (PPO)	01	04		1			H1608	031	0	2019	West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	035	0	1	04	01	H1608_035_0	3	1			2	08/03/2018	2019.01	08/03/2018 04:10:53 PM Central Daylight Time	08/02/2018 01:22:34 PM Central Daylight Time	07/31/2018 09:33:52 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra (PPO)	01	04		1			H1608	035	0	2019	Hannibal MO		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	036	0	1	04	01	H1608_036_0	3	1			2	08/03/2018	2019.01	08/03/2018 04:02:13 PM Central Daylight Time	08/03/2018 07:20:19 AM Central Daylight Time	07/31/2018 09:34:42 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Freedom (PPO)	01	04		1			H1608	036	0	2019	St. Joseph (KS and MO area)		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formular	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	037	0	1	04	01	H1608_037_0	3	1			2	08/01/2018	2019.01	08/01/2018 10:40:50 AM Eastern Daylight Time	08/02/2018 03:09:33 PM Eastern Daylight Time	07/31/2018 05:44:46 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Advantra Elite (PPO)	01	04		1			H1608	037	0	2019	Partial State of Iowa		2	44064	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	038	0	1	04	01	H1608_038_0	3	1			2	08/01/2018	2019.01	08/01/2018 10:41:32 AM Eastern Daylight Time	08/02/2018 03:10:38 PM Eastern Daylight Time	07/31/2018 05:45:26 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Advantra Elite (PPO)	01	04		1			H1608	038	0	2019	Partial State of Nebraska		2	5676	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	039	0	1	04	01	H1608_039_0	3	1			2	08/02/2018	2019.01	08/02/2018 06:00:09 PM Central Daylight Time	08/03/2018 07:21:18 AM Central Daylight Time	07/31/2018 09:35:34 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Freedom Plus (PPO)	01	04		1			H1608	039	0	2019	Western Mo Eastern Kansas		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	040	0	1	04	01	H1608_040_0	2	1			2	08/01/2018	2019.01	08/01/2018 06:41:00 PM Eastern Daylight Time	08/02/2018 07:19:10 PM Eastern Daylight Time	07/31/2018 11:01:10 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (PPO)	01	04		1			H1608	040	0	2019	Southern West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	041	0	1	04	01	H1608_041_0	2	1			2	08/01/2018	2019.01	08/01/2018 06:42:32 PM Eastern Daylight Time	08/02/2018 07:20:05 PM Eastern Daylight Time	07/31/2018 11:02:02 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (PPO)	01	04		1			H1608	041	0	2019	Northern West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	043	0	1	04	01	H1608_043_0	3	1			2	08/01/2018	2019.01	08/01/2018 10:42:29 AM Eastern Daylight Time	08/02/2018 03:11:50 PM Eastern Daylight Time	07/31/2018 05:46:05 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Advantra Elite (PPO)	01	04		1			H1608	043	0	2019	Partial State of South Dakota		2	468	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	047	0	1	04	01	H1608_047_0	3	1			2	08/02/2018	2019.01	08/02/2018 06:00:27 PM Central Daylight Time	08/03/2018 07:25:23 AM Central Daylight Time	07/31/2018 09:36:26 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Freedom Plus (PPO)	01	04		1			H1608	047	0	2019	Southwest Missouri, Southeast Kansas		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	048	0	1	04	01	H1608_048_0	3	1			2	08/01/2018	2019.01	08/01/2018 10:43:29 AM Eastern Daylight Time	08/01/2018 04:13:22 PM Eastern Daylight Time	07/31/2018 05:46:44 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Advantra Diamond (PPO)	01	04		1			H1608	048	0	2019	Polk County (IA)		2	2556	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	050	0	1	04	01	H1608_050_0	3	1			2	08/03/2018	2019.01	08/03/2018 04:06:05 PM Central Daylight Time	08/02/2018 01:24:06 PM Central Daylight Time	07/31/2018 09:37:22 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Freedom Plus (PPO)	01	04		1			H1608	050	0	2019	St Louis Metro		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	051	0	1	04	01	H1608_051_0	3	1			2	08/03/2018	2019.01	08/03/2018 04:06:34 PM Central Daylight Time	08/02/2018 01:25:36 PM Central Daylight Time	07/31/2018 09:38:12 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Freedom (PPO)	01	04		1			H1608	051	0	2019	Cape Girardeau, MO		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	801	0	1	04	01	H1608_801_0	2	1				06/01/2018	2019.01	06/01/2018 10:43:48 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/NoRx/Cyear (PPO)	01	04		1			H1608	801	0	2019	Partial State of Iowa and South Dakota		1	120	2			2						PharmacyLocator.coventry-medicare.com	IANEFormulary.coventry-medicare.com	ProviderDirectory.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	802	0	1	04	01	H1608_802_0	2	1				06/01/2018	2019.01	06/01/2018 10:43:34 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/Rx/Cyear (PPO)	01	04		1			H1608	802	0	2019	Partial State of Iowa and South Dakota		1	120	2			2						PharmacyLocator.coventry-medicare.com	IANEFormulary.coventry-medicare.com	ProviderDirectory.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	814	0	1	04	01	H1608_814_0	2	1				06/01/2018	2019.01	06/01/2018 10:43:19 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	St. Louis Employer Group w/o Rx (PPO)	01	04		1			H1608	814	0	2019	St Louis		1	120	2			2						www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.providerdirectory.coventry-medicare.com	(855)275-5888		(855)275-5888		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	815	0	1	04	01	H1608_815_0	2	1				06/01/2018	2019.01	06/01/2018 10:43:08 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	St. Louis Employer Group w/Rx (PPO)	01	04		1			H1608	815	0	2019	St. Louis		1	120	2			2						www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.providerdirectory.coventry-medicare.com	(855)275-5888		(855)275-5888		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	816	0	1	04	01	H1608_816_0	2	1				06/01/2018	2019.01	06/01/2018 10:43:01 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Ohio Employer Group w/Rx (PPO)	01	04		1			H1608	816	0	2019	Ohio		1	120	2			2						http//pharmacylocator.coventry-medicare.com	http//www.formulary.coventry-medicare.com	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	817	0	1	04	01	H1608_817_0	2	1				06/01/2018	2019.01	06/01/2018 10:42:52 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	https://www.coventry-medicare.com/en/prescription-	Heartland Employer Group w/o Rx (PPO)	01	04		1			H1608	817	0	2019	Heartland		1	740	2			2						https://www.coventry-medicare.com/en/prescription-drugs/find-pharmacy.html	https://www.coventry-medicare.com/en/for-members/group-plans.html	https://www.coventry-medicare.com/en/find-doctors-hospitals/find-provider.html	(855)322-7558		(855)322-7558		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	818	0	1	04	01	H1608_818_0	2	1				06/01/2018	2019.01	06/01/2018 10:44:16 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Ohio Employer Group w/o Rx (PPO)	01	04		1			H1608	818	0	2019	Ohio		1	120	2			2						http//pharmacylocator.coventry-medicare.com	http//www.formulary.coventry-medicare.com	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	819	0	1	04	01	H1608_819_0	2	1				06/01/2018	2019.01	06/01/2018 10:44:44 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Heartland Employer Group w/Rx (PPO)	01	04		1			H1608	819	0	2019	Heartland		1	11500	2			2						https://www.coventry-medicare.com/en/prescription-drugs/find-pharmacy.html	https://www.coventry-medicare.com/en/for-members/group-plans.html	https://www.coventry-medicare.com/en/find-doctors-hospitals/find-provider.html	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	822	0	1	04	01	H1608_822_0	2	1				06/01/2018	2019.01	06/01/2018 10:45:10 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra MA Only (PPO)	01	04		1			H1608	822	0	2019	West Virginia		1	17400	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	823	0	1	04	01	H1608_823_0	2	1				06/01/2018	2019.01	06/01/2018 10:45:37 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H1608	823	0	2019	West Virginia		1	3770	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888		(844)741-8423		(844)741-8423		(855)275-5888		(855)275-5888		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	824	0	1	04	01	H1608_824_0	2	1				06/01/2018	2019.01	06/01/2018 10:46:02 PM Eastern Daylight Time					06/01/2018 11:09:55 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.coventry-medicare.com	Coventry Advantra (PPO)	01	04		1			H1608	824	0	2019	North Carolina		1	120	2			2						http//pharmacylocator.coventry-medicare.com	http//www.formulary.coventry-medicare.com	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272		(844)741-8423		(844)741-8423		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1609	001	0	1	01	01	H1609_001_0	3	1				08/01/2018	2019.01	08/01/2018 10:44:14 AM Eastern Daylight Time	08/01/2018 04:15:27 PM Eastern Daylight Time	07/31/2018 05:47:25 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Advantra Silver (HMO)	01	01		1			H1609	001	0	2019	Partial State of Iowa		2	55236	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	009	0	1	01	01	H1609_009_0	2	1				08/01/2018	2019.01	08/01/2018 10:44:34 AM Eastern Daylight Time	08/01/2018 04:18:20 PM Eastern Daylight Time	07/31/2018 05:48:05 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Total Care (HMO)	01	01		1			H1609	009	0	2019	Dallas, Polk, Warren Counties Iowa		2	12816	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	014	0	1	01	01	H1609_014_0	3	1				08/02/2018	2019.01	08/02/2018 07:26:15 PM Eastern Daylight Time	08/03/2018 10:17:27 AM Eastern Daylight Time	07/31/2018 10:44:48 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Vista Plan (HMO)	01	01		1			H1609	014	0	2019	South FL		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	015	0	1	01	01	H1609_015_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 11:34:26 AM Eastern Daylight Time	08/03/2018 10:19:35 AM Eastern Daylight Time	07/31/2018 10:45:36 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Vista Plan (HMO SNP)	01	01		1			H1609	015	0	2019	South FL		2		2			1	3		2		2	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	016	0	1	01	01	H1609_016_0	3	1				08/02/2018	2019.01	08/02/2018 07:26:06 PM Eastern Daylight Time	08/03/2018 10:20:50 AM Eastern Daylight Time	07/31/2018 10:46:38 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO)	01	01		1			H1609	016	0	2019	South FL		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	017	0	1	01	01	H1609_017_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 11:34:44 AM Eastern Daylight Time	08/03/2018 10:22:52 AM Eastern Daylight Time	07/31/2018 10:47:36 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO SNP)	01	01		1			H1609	017	0	2019	South FL		2		2			1	3		2		2	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	018	0	1	01	01	H1609_018_0	3	1				08/02/2018	2019.01	08/02/2018 07:25:52 PM Eastern Daylight Time	08/03/2018 10:24:05 AM Eastern Daylight Time	07/31/2018 10:48:30 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO)	01	01		1			H1609	018	0	2019	South FL		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	019	0	1	01	01	H1609_019_0	2	1	2	1		05/15/2018	2019.01	05/15/2018 10:24:15 AM Eastern Daylight Time	08/03/2018 10:24:57 AM Eastern Daylight Time	07/31/2018 10:49:20 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO SNP)	01	01		1			H1609	019	0	2019	South FL, Treasure Coast FL, West FL		2		2			1	3		2		2	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	020	0	1	01	01	H1609_020_0	2	1				08/02/2018	2019.01	08/02/2018 07:26:30 PM Eastern Daylight Time	08/03/2018 10:30:59 AM Eastern Daylight Time	07/31/2018 10:50:12 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO)	01	01		1			H1609	020	0	2019	South FL, Treasure Coast		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	021	0	1	01	01	H1609_021_0	2	1				08/02/2018	2019.01	08/02/2018 07:26:44 PM Eastern Daylight Time	08/03/2018 10:33:40 AM Eastern Daylight Time	07/31/2018 10:51:06 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO)	01	01		1			H1609	021	0	2019	North FL, Treasure Coast FL		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	022	0	1	01	01	H1609_022_0	3	1				08/02/2018	2019.01	08/02/2018 07:16:16 PM Eastern Daylight Time	08/03/2018 10:35:57 AM Eastern Daylight Time	07/31/2018 10:52:00 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO)	01	01		1			H1609	022	0	2019	West FL		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	023	0	1	01	01	H1609_023_0	2	1	2	1		05/15/2018	2019.01	05/15/2018 10:28:30 AM Eastern Daylight Time	08/03/2018 10:36:51 AM Eastern Daylight Time	07/31/2018 10:52:50 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO SNP)	01	01		1			H1609	023	0	2019	Central FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	024	0	1	01	01	H1609_024_0	2	1				08/02/2018	2019.01	08/02/2018 07:17:05 PM Eastern Daylight Time	08/03/2018 10:38:02 AM Eastern Daylight Time	07/31/2018 10:53:44 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1609	024	0	2019	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	025	0	1	01	01	H1609_025_0	2	1				08/02/2018	2019.01	08/02/2018 07:19:22 PM Eastern Daylight Time	08/03/2018 10:45:16 AM Eastern Daylight Time	07/31/2018 10:54:36 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1609	025	0	2019	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	026	0	1	01	01	H1609_026_0	2	1				08/02/2018	2019.01	08/02/2018 07:23:25 PM Eastern Daylight Time	08/03/2018 10:46:40 AM Eastern Daylight Time	07/31/2018 10:55:32 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H1609	026	0	2019	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	027	0	1	01	01	H1609_027_0	2	1				08/02/2018	2019.01	08/02/2018 07:24:30 PM Eastern Daylight Time	08/03/2018 10:48:11 AM Eastern Daylight Time	07/31/2018 10:56:22 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1609	027	0	2019	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	028	0	1	02	01	H1609_028_0	2	1				08/02/2018	2019.01	08/02/2018 07:25:17 PM Eastern Daylight Time	08/03/2018 03:44:53 PM Eastern Daylight Time	07/31/2018 10:57:16 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (HMO-POS)	01	02		1			H1609	028	0	2019	North, Central, West, SW, Treasure Coast, South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	034	0	1	01	01	H1609_034_0	2	1				08/02/2018	2019.01	08/02/2018 07:27:13 PM Eastern Daylight Time	08/03/2018 10:52:22 AM Eastern Daylight Time	07/31/2018 10:58:10 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO)	01	01		1			H1609	034	0	2019	West FL, Treasure Coast FL		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	035	0	1	01	01	H1609_035_0	2	1				08/02/2018	2019.01	08/02/2018 07:28:02 PM Eastern Daylight Time	08/03/2018 10:53:55 AM Eastern Daylight Time	07/31/2018 10:59:00 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1609	035	0	2019	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	037	0	1	01	01	H1609_037_0	2	1				08/02/2018	2019.01	08/02/2018 07:29:02 PM Eastern Daylight Time	08/03/2018 10:56:03 AM Eastern Daylight Time	07/31/2018 10:59:50 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1609	037	0	2019	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	038	0	1	01	01	H1609_038_0	2	1				08/02/2018	2019.01	08/02/2018 07:29:45 PM Eastern Daylight Time	08/03/2018 10:57:33 AM Eastern Daylight Time	07/31/2018 11:00:40 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1609	038	0	2019	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	039	0	1	01	01	H1609_039_0	2	1	2	1		05/15/2018	2019.01	05/15/2018 10:32:31 AM Eastern Daylight Time	08/03/2018 10:59:28 AM Eastern Daylight Time	07/31/2018 11:01:32 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Medicare Summit Plan (HMO SNP)	01	01		1			H1609	039	0	2019	North FL		2		2			1	3		2		2	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	040	0	1	01	01	H1609_040_0	2	1	2	1		05/15/2018	2019.01	05/15/2018 10:32:43 AM Eastern Daylight Time	08/03/2018 11:00:53 AM Eastern Daylight Time	07/31/2018 11:02:22 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO SNP)	01	01		1			H1609	040	0	2019	Southwest FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	801	0	1	01	01	H1609_801_0	2	1				06/04/2018	2019.01	06/04/2018 11:41:08 AM Eastern Daylight Time					06/04/2018 12:01:27 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/NoRx/Cyear (HMO)	01	01		1			H1609	801	0	2019	Partial State of Iowa		1	120	2			2						PharmacyLocator.coventry-medicare.com	IANEFormulary.coventry-medicare.com	ProviderDirectory.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H1609	802	0	1	01	01	H1609_802_0	2	1				06/04/2018	2019.01	06/04/2018 11:42:31 AM Eastern Daylight Time					06/04/2018 12:01:27 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/Rx/Cyear (HMO)	01	01		1			H1609	802	0	2019	Partial State of Iowa		1	120	2			2						PharmacyLocator.coventry-medicare.com	IANEFormulary.coventry-medicare.com	ProviderDirectory.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-7027		(866)294-1211		(866)294-1211		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H1609	807	0	1	01	01	H1609_807_0	2	1				06/04/2018	2019.01	06/04/2018 11:44:45 AM Eastern Daylight Time					06/04/2018 12:01:27 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnaretireeplans.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H1609	807	0	2019	Florida		1	3200	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(844)332-9495		(844)322-9495		(800)307-4830		(800)307-4830		(844)332-9495		(844)322-9495		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H1609	808	0	1	01	01	H1609_808_0	2	1				06/04/2018	2019.01	06/04/2018 11:45:27 AM Eastern Daylight Time					06/04/2018 12:01:27 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnaretireeplans.com	Aetna Medicare (HMO)	01	01		1			H1609	808	0	2019	Florida		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicaredocfind.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-7027										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H1610	001	0	1	01	01	H1610_001_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 09:04:06 PM Eastern Daylight Time	08/02/2018 12:01:29 PM Eastern Daylight Time	07/31/2018 11:02:54 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA	Aetna Better Health of Virginia	www.aetnabetterhealth.com/virginia-hmosnp	Aetna Better Health, Inc. (HMO SNP)	01	01		1			H1610	001	0	2019	Virginia		2		2			1	3		1		2	www.aetnabetterhealth.com/virginia-hmosnp	www.aetnabetterhealth.com/virginia-hmosnp	www.aetnabetterhealth.com/virginia-hmosnp	(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1651	001	0	1	18	06	H1651_001_0	1	2				06/01/2018	2019.01	06/01/2018 09:59:10 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	001	0	2019	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	72000	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	002	0	1	18	06	H1651_002_0	1	2				06/01/2018	2019.01	06/01/2018 09:59:29 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Basic Plan (Cost)	06	18		1			H1651	002	0	2019	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	12	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	003	0	1	18	06	H1651_003_0	1	2				06/01/2018	2019.01	06/01/2018 09:59:41 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	003	0	2019	Jo Daviess County		2	14688	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	004	0	1	18	06	H1651_004_0	1	2				06/01/2018	2019.01	06/01/2018 09:59:56 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	004	0	2019	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	40037	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	005	0	1	18	06	H1651_005_0	1	2				06/01/2018	2019.01	06/01/2018 10:00:17 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	005	0	2019	Jo Daviess County		2	5740	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	008	0	1	18	06	H1651_008_0	1	2				06/01/2018	2019.01	06/01/2018 10:00:42 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	008	0	2019	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	8200	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	009	0	1	18	06	H1651_009_0	1	2				06/01/2018	2019.01	06/01/2018 10:01:09 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	009	0	2019	Jo Daviess County		2	2178	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	010	0	1	18	06	H1651_010_0	1	2				06/01/2018	2019.01	06/01/2018 10:01:20 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Cedar Valley Health Senior Plan (Cost)	06	18		1			H1651	010	0	2019	Cedar Valley		2	600	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	011	0	1	18	06	H1651_011_0	1	2				06/01/2018	2019.01	06/01/2018 10:01:36 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Central Iowa Health Senior Plan (Cost)	06	18		1			H1651	011	0	2019	Central Iowa		2	1200	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	012	0	1	18	06	H1651_012_0	1	2				06/01/2018	2019.01	06/01/2018 10:01:51 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Clinton Community Health Senior Plan (Cost)	06	18		1			H1651	012	0	2019	Clinton, Scott, Jackson, Cedar Counties		2	600	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	013	0	1	18	06	H1651_013_0	1	2				06/01/2018	2019.01	06/01/2018 10:02:06 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Genesis Health Network Senior Plan (Cost)	06	18		1			H1651	013	0	2019	Clinton, Scott, Jackson, Cedar, Muscatine Counties		2	600	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	014	0	1	18	06	H1651_014_0	1	2				06/01/2018	2019.01	06/01/2018 10:02:19 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Mercy Cedar Rapids Senior Plan (Cost)	06	18		1			H1651	014	0	2019	Cedar Rapids and Surrounding Counties		2	600	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	015	0	1	18	06	H1651_015_0	1	2				06/01/2018	2019.01	06/01/2018 10:02:34 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	North Iowa Health Senior Plan (Cost)	06	18		1			H1651	015	0	2019	North Iowa		2	600	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	016	0	1	18	06	H1651_016_0	1	2				06/01/2018	2019.01	06/01/2018 10:02:50 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Priority Health Network Senior Plan (Cost)	06	18		1			H1651	016	0	2019	Iowa, Johnson, Cedar Washington Muscatine Counties		2	600	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1659	001	0	1	04	01	H1659_001_0	6	1				08/02/2018	2019.01	08/02/2018 04:55:06 PM Central Daylight Time	08/03/2018 11:46:54 AM Central Daylight Time	08/01/2018 05:37:44 PM Central Daylight Time			08/06/2018 05:08:35 PM Central Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option One (PPO)	01	04		1			H1659	001	0	2019	City: LYH Counties: AM,AP,BE,CA,CLT,HA,PE,PI		2	11944	2			2						www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1659	002	0	1	04	01	H1659_002_0	6	1				08/02/2018	2019.01	08/02/2018 04:57:00 PM Central Daylight Time	08/03/2018 11:48:02 AM Central Daylight Time	08/01/2018 05:38:28 PM Central Daylight Time			08/06/2018 05:08:35 PM Central Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Two (PPO)	01	04		1			H1659	002	0	2019	City: LYH Counties: AM,AP,BE,CA,CLT,HA,PE,PI		2	19379	2			2						www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1659	003	0	1	04	01	H1659_003_0	7	1				08/02/2018	2019.01	08/02/2018 04:58:44 PM Central Daylight Time	08/03/2018 11:49:10 AM Central Daylight Time	08/01/2018 05:39:06 PM Central Daylight Time			08/06/2018 05:08:35 PM Central Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Three (PPO)	01	04		1			H1659	003	0	2019	City: LYH Counties: AM,AP,BE,CA,CLT,HA,PE,PI		2	29995	2			2						www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1660	013	0	1	01	01	H1660_013_0	5	1				08/08/2018	2019.01	08/08/2018 12:54:37 AM Eastern Daylight Time	08/06/2018 02:14:56 PM Eastern Daylight Time	08/02/2018 11:17:08 AM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	013	0	2019	Maine		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	014	0	1	01	01	H1660_014_0	5	1				08/08/2018	2019.01	08/08/2018 12:49:01 AM Eastern Daylight Time	08/06/2018 01:57:06 PM Eastern Daylight Time	08/02/2018 11:19:00 AM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Basic Rx (HMO)	01	01		1			H1660	014	0	2019	Massachusetts		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	015	0	1	01	01	H1660_015_0	5	1				08/08/2018	2019.01	08/08/2018 12:53:09 AM Eastern Daylight Time	08/06/2018 02:00:08 PM Eastern Daylight Time	08/02/2018 11:43:00 AM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Basic Rx (HMO)	01	01		1			H1660	015	0	2019	Maine		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	016	1	1	01	01	H1660_016_1	5	1				07/17/2018	2019.01	07/17/2018 01:15:18 AM Eastern Daylight Time	08/06/2018 02:28:22 PM Eastern Daylight Time	08/02/2018 11:48:18 AM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	016	1	2019	Massachusetts	Worcester County MA	2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	016	2	1	01	01	H1660_016_2	5	1				07/17/2018	2019.01	07/17/2018 01:17:25 AM Eastern Daylight Time	08/06/2018 02:32:44 PM Eastern Daylight Time	08/02/2018 11:57:14 AM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	016	2	2019	Massachusetts	Eastern Massachusetts	2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	017	1	1	01	01	H1660_017_1	5	1				07/17/2018	2019.01	07/17/2018 01:19:12 AM Eastern Daylight Time	08/06/2018 02:08:32 PM Eastern Daylight Time	08/02/2018 12:00:38 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	017	1	2019	Massachusetts	Worcester County MA	2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	017	2	1	01	01	H1660_017_2	5	1				07/17/2018	2019.01	07/17/2018 01:20:22 AM Eastern Daylight Time	08/06/2018 02:19:18 PM Eastern Daylight Time	08/02/2018 12:05:02 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	017	2	2019	Massachusetts	Eastern Massachusetts	2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	801	0	1	01	01	H1660_801_0	2	1				07/17/2018	2019.01	07/17/2018 01:45:42 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	801	0	2019	Massachusetts & Maine		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	802	0	1	01	01	H1660_802_0	2	1				07/17/2018	2019.01	07/17/2018 01:45:57 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	802	0	2019	Massachusetts & Maine		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	803	0	1	01	01	H1660_803_0	2	1				07/17/2018	2019.01	07/17/2018 01:46:11 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	803	0	2019	Massachusetts & Maine		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	804	0	1	01	01	H1660_804_0	2	1				07/17/2018	2019.01	07/17/2018 01:46:26 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	804	0	2019	Massachusetts & Maine		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	001	0	1	01	01	H1664_001_0	5	1				08/01/2018	2019.01	08/01/2018 11:53:03 AM US Mountain Standard Time	08/04/2018 01:55:31 PM Pacific Daylight Time	08/04/2018 01:55:37 PM Pacific Daylight Time			08/04/2018 01:59:45 PM Pacific Daylight Time	HOME STATE HEALTH PLAN, INC.	Allwell	allwell.homestatehealth.com	Allwell Medicare (HMO)	01	01		1			H1664	001	0	2019	10 counties in SW Missouri		2		2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	002	0	1	01	01	H1664_002_0	5	1				08/01/2018	2019.01	08/01/2018 11:55:02 AM US Mountain Standard Time	08/04/2018 01:55:44 PM Pacific Daylight Time	08/04/2018 01:55:47 PM Pacific Daylight Time			08/04/2018 01:59:45 PM Pacific Daylight Time	HOME STATE HEALTH PLAN, INC.	Allwell	allwell.homestatehealth.com	Allwell Medicare (HMO)	01	01		1			H1664	002	0	2019	Cass, Clay, Jackson, Platte		2		2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	004	0	1	01	01	H1664_004_0	5	1				08/01/2018	2019.01	08/01/2018 11:57:59 AM US Mountain Standard Time	08/04/2018 01:55:56 PM Pacific Daylight Time	08/04/2018 01:56:02 PM Pacific Daylight Time			08/04/2018 01:59:45 PM Pacific Daylight Time	HOME STATE HEALTH PLAN, INC.	Allwell	allwell.homestatehealth.com	Allwell Medicare (HMO)	01	01		1			H1664	004	0	2019	7 counties in East Missouri		2		2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	005	0	1	01	01	H1664_005_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 03:06:11 PM Pacific Daylight Time	08/04/2018 01:56:11 PM Pacific Daylight Time	08/04/2018 01:56:33 PM Pacific Daylight Time			08/04/2018 01:59:45 PM Pacific Daylight Time	HOME STATE HEALTH PLAN, INC.	Allwell	allwell.homestatehealth.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H1664	005	0	2019	21 counties in West and South Missouri		2		2			1	3		1		1	allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	801	0	1	01	01	H1664_801_0	1	1				05/29/2018	2019.01	05/29/2018 04:08:17 PM Pacific Daylight Time					06/03/2018 03:22:41 PM Pacific Daylight Time	HOME STATE HEALTH PLAN, INC.	Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	801	0	2019	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/find-doctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1664	802	0	1	01	01	H1664_802_0	1	1				05/29/2018	2019.01	05/29/2018 05:27:34 PM Pacific Daylight Time					06/03/2018 03:22:41 PM Pacific Daylight Time	HOME STATE HEALTH PLAN, INC.	Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	802	0	2019	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/find-doctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1664	803	0	1	01	01	H1664_803_0	1	1				05/29/2018	2019.01	05/29/2018 04:08:31 PM Pacific Daylight Time					06/03/2018 03:22:41 PM Pacific Daylight Time	HOME STATE HEALTH PLAN, INC.	Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	803	0	2019	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/find-doctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1666	001	0	1	04	01	H1666_001_0	7	1				07/09/2018	2019.01	07/09/2018 11:23:22 AM Central Daylight Time	08/06/2018 12:42:29 PM Central Daylight Time	08/01/2018 11:46:09 AM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	001	0	2019	Austin metro area		2	15441	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	002	0	1	04	01	H1666_002_0	7	1				07/09/2018	2019.01	07/09/2018 11:24:04 AM Central Daylight Time	08/06/2018 12:43:15 PM Central Daylight Time	08/01/2018 11:46:55 AM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	002	0	2019	Dallas, Tarrant, Collin, and Denton counties		2	18164	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	003	0	1	04	01	H1666_003_0	7	1				07/09/2018	2019.01	07/09/2018 11:24:37 AM Central Daylight Time	08/06/2018 12:44:01 PM Central Daylight Time	08/01/2018 11:47:41 AM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	003	0	2019	Harris, Fort Bend, and Montgomery counties		2	25675	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	004	0	1	04	01	H1666_004_0	11	1				07/09/2018	2019.01	07/09/2018 11:25:20 AM Central Daylight Time	08/06/2018 12:44:46 PM Central Daylight Time	08/01/2018 11:48:26 AM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	004	0	2019	Austin Metro Area		2	19378	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	005	0	1	04	01	H1666_005_0	7	1				07/09/2018	2019.01	07/09/2018 11:25:57 AM Central Daylight Time	08/06/2018 12:45:32 PM Central Daylight Time	08/01/2018 11:49:11 AM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	005	0	2019	Dallas Metro Area		2	26380	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	006	0	1	04	01	H1666_006_0	7	1				07/09/2018	2019.01	07/09/2018 11:26:35 AM Central Daylight Time	08/06/2018 12:46:18 PM Central Daylight Time	08/01/2018 11:49:57 AM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	006	0	2019	Houston Metro Area		2	35286	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	008	0	1	04	01	H1666_008_0	7	1				07/09/2018	2019.01	07/09/2018 11:27:10 AM Central Daylight Time	08/06/2018 12:47:03 PM Central Daylight Time	08/01/2018 05:32:52 PM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	008	0	2019	San Antonio		2	5281	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	801	0	1	04	01	H1666_801_0	3	1				06/18/2018	2019.01	06/18/2018 02:04:06 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	BlueCross Medicare Advantage (PPO)	01	04		1			H1666	801	0	2019	State of Texas		1	57308	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H1666	803	0	1	04	01	H1666_803_0	3	1				06/18/2018	2019.01	06/18/2018 01:53:35 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	BlueCross  Medicare Advantage (PPO)	01	04		1			H1666	803	0	2019	State of Texas		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1									
H1666	805	0	1	04	01	H1666_805_0	3	1				06/18/2018	2019.01	06/18/2018 01:53:52 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	BlueCross  Medicare Advantage (PPO)	01	04		1			H1666	805	0	2019	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H1666	807	0	2	04	01	H1666_807_0	3	1				06/18/2018	2019.01	06/18/2018 01:54:11 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage (PPO)	01	04		2	2		H1666	807	0	2019	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;	2		1									
H1666	808	0	2	04	01	H1666_808_0	3	1				06/18/2018	2019.01	06/18/2018 01:54:26 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage (PPO)	01	04		2	2		H1666	808	0	2019	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1									
H1692	002	0	1	01	01	H1692_002_0	4	1				08/02/2018	2019.01	08/02/2018 09:19:46 AM Eastern Daylight Time	08/02/2018 07:21:09 PM Eastern Daylight Time	07/31/2018 11:03:48 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (HMO)	01	01		1			H1692	002	0	2019	Southern West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	003	0	1	01	01	H1692_003_0	2	1				08/02/2018	2019.01	08/02/2018 09:21:49 AM Eastern Daylight Time	08/02/2018 07:22:38 PM Eastern Daylight Time	07/31/2018 11:04:40 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Choice (HMO)	01	01		1			H1692	003	0	2019	Northern West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	004	0	1	01	01	H1692_004_0	2	1				08/02/2018	2019.01	08/02/2018 09:23:08 AM Eastern Daylight Time	08/02/2018 07:23:32 PM Eastern Daylight Time	07/31/2018 11:05:36 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Choice (HMO)	01	01		1			H1692	004	0	2019	Southern West Virginia		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	801	0	1	01	01	H1692_801_0	4	1				06/04/2018	2019.01	06/04/2018 11:05:03 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra MA Only (HMO)	01	01		1			H1692	801	0	2019	West Virginia		1	120	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H1692	802	0	1	01	01	H1692_802_0	4	1				06/04/2018	2019.01	06/04/2018 11:08:45 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H1692	802	0	2019	West Virginia		1	120	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888		(844)741-8423		(844)741-8423		(855)275-5888		(855)275-5888		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H1714	001	0	1	20	08	H1714_001_0	1	1				05/30/2018	2019.01	05/30/2018 03:05:44 PM Central Daylight Time		05/30/2018 02:24:02 PM Central Daylight Time			05/30/2018 03:08:57 PM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	Via Christi HOPE	viachristi.org	Via Christi HOPE (PACE)	08	20		1			H1714	001	0	2019	Sedgwick County		2		2			2						www.viachristihope.com	www.viachristihope.com												(316)858-1111				(316)858-1111										(180)076-6377		(180)076-6377		(180)076-6377		(180)076-6377																
H1714	002	0	1	20	08	H1714_002_0	1	1				05/30/2018	2019.01	05/30/2018 03:06:53 PM Central Daylight Time		05/30/2018 02:24:02 PM Central Daylight Time			05/30/2018 03:08:57 PM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	Via Christi HOPE	viachristi.org	Via Christi HOPE (PACE)	08	20		1			H1714	002	0	2019	Sedgwick County		2		2			2						www.viachristihope.com	www.viachristihope.com												(316)858-1111				(316)858-1111										(180)076-6377		(180)076-6377		(180)076-6377		(180)076-6377																
H1722	001	0	1	01	01	H1722_001_0	5	1		1		08/06/2018	2019.01	08/06/2018 10:34:42 AM Central Daylight Time	08/07/2018 09:38:31 AM Central Daylight Time	08/07/2018 09:40:51 AM Central Daylight Time			08/07/2018 05:02:06 PM Central Daylight Time	HEALTH POINTE OF NEW YORK, LLC	Health Pointe of New York, LLC	http://healthpointeny.com	Health Pointe Direct Complete Plan (HMO SNP)	01	01		1			H1722	001	0	2019	Counties: NY, KNG, QNS, BRX, NAS, WC		2	2940	2			1	1	1				healthpointeny.com	http://healthpointeny.com	http://healthpointeny.com	(844)269-3442		(718)637-2075		(844)269-3442		(718)637-2075		(844)269-3442		(718)637-2075		(844)269-3442		(718)637-2075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1723	001	0	1	48	05	H1723_001_0	4	1				07/02/2018	2019.01	07/02/2018 04:50:49 PM Eastern Daylight Time					07/03/2018 11:39:08 AM Pacific Daylight Time	ABSOLUTE TOTAL CARE, INC.	Absolute Total Care	mmp.absolutetotalcare.com	Absolute Total Care (Medicare-Medicaid Plan)	05	48		1			H1723	001	0	2019	Statewide		2	2008	2			2						mmp.absolutetotalcare.com/mmp/benefits/find-a-doctor-or-pharmacy.html	mmp.absolutetotalcare.com/mmp/prescription-drug-part-d/formulary.html	mmp.absolutetotalcare.com/mmp/benefits/find-a-doctor-or-pharmacy.html	(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H1737	001	0	1	01	01	H1737_001_0	13	1				08/02/2018	2019.01	08/02/2018 01:44:33 PM Central Daylight Time	08/03/2018 04:16:50 PM Central Daylight Time	08/03/2018 01:55:55 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Guide HMO Rx (HMO)	01	01		1			H1737	001	0	2019	Scott County		2	10605	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1737	801	0	1	01	01	H1737_801_0	3	1				06/05/2018	2019.01	06/05/2018 09:39:29 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1737	801	0	2019	Health Alliance Medicare		1	120	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H1737	802	0	1	01	01	H1737_802_0	3	1				06/05/2018	2019.01	06/05/2018 09:29:48 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1737	802	0	2019	Health Alliance Medicare		1	1200	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1737	803	0	1	01	01	H1737_803_0	3	1				06/05/2018	2019.01	06/05/2018 09:30:46 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	01	01		1			H1737	803	0	2019	Health Alliance Medicare		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1777	007	0	1	01	01	H1777_007_0	7	1		1		08/06/2018	2019.01	08/06/2018 03:22:15 PM Eastern Daylight Time	08/07/2018 03:03:45 PM Eastern Daylight Time	08/07/2018 03:03:45 PM Eastern Daylight Time			08/07/2018 03:15:05 PM Eastern Daylight Time	CATHOLIC SPECIAL NEEDS PLAN, LLC	ArchCare Advantage	www.archcareadvantage.org	ArchCare  Advantage (HMO SNP)	01	01		1			H1777	007	0	2019	NYC, Westchester, Putnam, Dutchess, Orange, Ononda		2	23904	2			1	1	3				www.archcareadvantage.org	www.archcareadvantage.org	www.archcareadvantage.org	(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(888)816-7977		(888)816-7977		(800)373-3177		(800)373-3177		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H1787	001	0	1	01	01	H1787_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:05:40 AM Eastern Daylight Time	08/07/2018 02:52:01 PM Eastern Daylight Time	08/07/2018 02:52:01 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF SOUTH DAKOTA, INC	Great Plains Medicare Advantage (HMO SNP)	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO SNP)	01	01		1			H1787	001	0	2019	South Dakota (partial)		2	3720	2			1	1	1				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1846	004	0	1	04	01	H1846_004_0	5	1				07/16/2018	2019.01	07/16/2018 04:24:02 PM Eastern Daylight Time	08/03/2018 12:31:11 PM Eastern Daylight Time	08/03/2018 12:50:19 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Flexible Choice (PPO)	01	04		1			H1846	004	0	2019	Select Ohio Counties		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1846	801	0	1	04	01	H1846_801_0	1	1				05/30/2018	2019.01	05/30/2018 09:41:58 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	EGWP MediGold Network Choice (PPO)	01	04		1			H1846	801	0	2019	Greater Central Ohio and Dayton Area		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1									
H1846	802	0	1	04	01	H1846_802_0	1	1				05/30/2018	2019.01	05/30/2018 09:42:58 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	EGWP MediGold Network Choice Medical Only (PPO)	01	04		1			H1846	802	0	2019	Greater Central Ohio and Dayton Area		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1									
H1894	001	0	1	01	01	H1894_001_0	8	1				08/03/2018	2019.01	08/03/2018 07:32:34 PM Pacific Daylight Time	08/05/2018 08:33:46 PM Pacific Daylight Time	08/01/2018 04:53:00 PM Pacific Daylight Time			08/06/2018 03:26:51 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H1894	001	0	2019	Washington Counties		2	14449	2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)288-5923		(844)288-5923		(866)805-4589		(866)805-4589		(844)288-7618		(844)288-7618		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1894	002	0	1	01	01	H1894_002_0	8	1	2	1		08/02/2018	2019.01	08/02/2018 11:42:02 AM Pacific Daylight Time	08/05/2018 08:34:46 PM Pacific Daylight Time	08/01/2018 03:13:42 PM Pacific Daylight Time			08/06/2018 03:26:51 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H1894	002	0	2019	Washington Counties		2	5912	2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(844)812-2275		(844)812-2275		(844)288-5923		(844)288-5923		(844)812-2275		(844)812-2275		(844)288-7618		(844)288-7618		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1904	001	0	1	20	08	H1904_001_0	1	1				05/23/2018	2019.01	05/23/2018 09:57:24 AM Central Daylight Time		05/23/2018 09:22:22 AM Central Daylight Time			05/23/2018 10:01:32 AM Central Daylight Time	PACE GREATER NEW ORLEANS	Pace Greater New Orleans	http://pacegno.org/	PACE Greater New Orleans (PACE)	08	20		1			H1904	001	0	2019	PACE Greater New Orleans		2		2			2						http://www.pacegno.org	http://www.pacegno.org										(866)395-8509		(504)835-0006		(866)395-8509		(504)835-0006										(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277																
H1904	002	0	1	20	08	H1904_002_0	1	1				05/23/2018	2019.01	05/23/2018 09:58:20 AM Central Daylight Time		05/23/2018 09:22:23 AM Central Daylight Time			05/23/2018 10:01:32 AM Central Daylight Time	PACE GREATER NEW ORLEANS	Pace Greater New Orleans	http://pacegno.org/	PACE Greater New Orleans (PACE)	08	20		1			H1904	002	0	2019	PACE Greater New Orleans		2		2			2						http://www.pacegno.org	http://www.pacegno.org										(866)395-8509		(504)835-0006		(866)395-8509		(504)835-0006										(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277																
H1924	001	0		07	02	H1924_001_0	6	2				05/25/2018	2019.01	05/25/2018 06:34:54 PM Eastern Daylight Time			06/02/2018 01:52:16 PM Eastern Daylight Time		06/02/2018 01:53:32 PM Eastern Daylight Time	PORT HOLDINGS, INC.	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare (MSA)	02	07	2				H1924	001	0	2019	Lasso Healthcare Region 1		2	1000	1	1		2											(717)540-3720				(717)540-3720										(800)769-1847		(717)540-3720		(800)769-1847		(717)540-3720																								
H1924	002	0		07	02	H1924_002_0	6	2				05/21/2018	2019.01	05/21/2018 12:16:14 PM Eastern Daylight Time			06/02/2018 01:52:16 PM Eastern Daylight Time		06/02/2018 01:55:08 PM Eastern Daylight Time	PORT HOLDINGS, INC.	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare (MSA)	02	07	2				H1924	002	0	2019	Lasso Healthcare Region 2		2	1000	1	1		2											(717)540-3720				(717)540-3720										(800)769-1847		(717)540-3720		(800)769-1847		(717)540-3720																								
H1924	003	0		07	02	H1924_003_0	6	2				05/21/2018	2019.01	05/21/2018 12:16:04 PM Eastern Daylight Time			06/02/2018 01:52:16 PM Eastern Daylight Time		06/02/2018 01:56:15 PM Eastern Daylight Time	PORT HOLDINGS, INC.	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare (MSA)	02	07	2				H1924	003	0	2019	Lasso Healthcare Region 3		2	1000	1	1		2											(717)540-3720				(717)540-3720										(800)769-1847		(717)540-3720		(800)769-1847		(717)540-3720																								
H1944	001	0	1	01	01	H1944_001_0	4	1				08/02/2018	2019.01	08/02/2018 01:47:17 PM Central Daylight Time	08/03/2018 09:22:38 AM Central Daylight Time	07/31/2018 06:04:28 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	001	0	2019	Middlesex and Suffolk counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	004	0	1	01	01	H1944_004_0	4	1				07/12/2018	2019.01	07/12/2018 12:27:45 PM Central Daylight Time	08/03/2018 09:23:14 AM Central Daylight Time	07/31/2018 06:04:50 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	004	0	2019	Middlesex and Suffolk counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	005	0	1	01	01	H1944_005_0	4	1				08/02/2018	2019.01	08/02/2018 01:47:59 PM Central Daylight Time	08/03/2018 09:23:50 AM Central Daylight Time	07/31/2018 06:05:14 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	005	0	2019	Select Counties in Massachusetts		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	006	0	1	01	01	H1944_006_0	4	1				07/12/2018	2019.01	07/12/2018 12:28:42 PM Central Daylight Time	08/03/2018 09:24:29 AM Central Daylight Time	07/31/2018 06:05:38 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	006	0	2019	Select Counties in Massachusetts		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	009	0	1	01	01	H1944_009_0	3	1				07/12/2018	2019.01	07/12/2018 12:40:23 PM Central Daylight Time	08/03/2018 09:25:06 AM Central Daylight Time	07/31/2018 06:06:00 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1944	009	0	2019	Bucks, Chester and Philadelphia Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	010	0	1	01	01	H1944_010_0	4	1				08/02/2018	2019.01	08/02/2018 02:43:33 PM Central Daylight Time	08/03/2018 09:25:44 AM Central Daylight Time	07/31/2018 06:06:22 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	010	0	2019	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	011	0	1	01	01	H1944_011_0	4	1				07/12/2018	2019.01	07/12/2018 12:47:24 PM Central Daylight Time	08/03/2018 09:26:23 AM Central Daylight Time	07/31/2018 06:06:46 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	011	0	2019	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	014	0	1	01	01	H1944_014_0	3	1				05/24/2018	2019.01	05/24/2018 10:46:49 AM Central Daylight Time	08/03/2018 09:26:59 AM Central Daylight Time	07/31/2018 06:07:08 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	014	0	2019	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	015	0	1	01	01	H1944_015_0	2	1				07/12/2018	2019.01	07/12/2018 12:29:26 PM Central Daylight Time	06/01/2018 04:09:56 PM Central Daylight Time				07/12/2018 05:50:17 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H1944	015	0	2019	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1944	016	0	1	01	01	H1944_016_0	4	1				08/02/2018	2019.01	08/02/2018 01:48:50 PM Central Daylight Time	08/03/2018 09:28:16 AM Central Daylight Time	07/31/2018 06:07:32 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	016	0	2019	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	017	0	1	01	01	H1944_017_0	3	1				07/12/2018	2019.01	07/12/2018 12:52:56 PM Central Daylight Time	08/03/2018 09:28:54 AM Central Daylight Time	07/31/2018 06:07:54 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	017	0	2019	Select counties in New Hampshire		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	018	0	1	01	01	H1944_018_0	4	1				07/12/2018	2019.01	07/12/2018 12:52:46 PM Central Daylight Time	08/03/2018 09:29:32 AM Central Daylight Time	07/31/2018 06:08:18 PM Central Daylight Time			08/06/2018 12:30:46 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	018	0	2019	Select counties in Vermont		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	019	0	1	01	01	H1944_019_0	4	1				07/12/2018	2019.01	07/12/2018 12:52:34 PM Central Daylight Time	08/03/2018 09:30:09 AM Central Daylight Time	07/31/2018 06:08:40 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H1944	019	0	2019	Select counties in New Hampshire		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	020	0	1	01	01	H1944_020_0	3	1				05/24/2018	2019.01	05/24/2018 10:49:10 AM Central Daylight Time	08/03/2018 09:30:46 AM Central Daylight Time	07/31/2018 06:09:02 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H1944	020	0	2019	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	021	0	1	01	01	H1944_021_0	4	1				07/12/2018	2019.01	07/12/2018 12:30:39 PM Central Daylight Time	08/03/2018 09:31:36 AM Central Daylight Time	07/31/2018 06:09:26 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H1944	021	0	2019	Middlesex and Suffolk counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	022	0	1	01	01	H1944_022_0	4	1				07/12/2018	2019.01	07/12/2018 12:31:17 PM Central Daylight Time	08/03/2018 09:32:16 AM Central Daylight Time	07/31/2018 06:09:48 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H1944	022	0	2019	Select Counties in Massachusetts		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	024	0	1	01	01	H1944_024_0	3	1				07/12/2018	2019.01	07/12/2018 12:52:25 PM Central Daylight Time	08/03/2018 09:32:54 AM Central Daylight Time	07/31/2018 06:10:14 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1944	024	0	2019	Philadelphia Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	025	0	1	01	01	H1944_025_0	3	1				07/12/2018	2019.01	07/12/2018 12:53:30 PM Central Daylight Time	08/03/2018 09:33:32 AM Central Daylight Time	07/31/2018 06:10:38 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H1944	025	0	2019	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	028	0	1	01	01	H1944_028_0	5	1				07/12/2018	2019.01	07/12/2018 12:54:01 PM Central Daylight Time	08/03/2018 09:34:10 AM Central Daylight Time	07/31/2018 06:11:00 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	028	0	2019	Select Counties in Vermont		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	030	0	1	01	01	H1944_030_0	2	1				07/12/2018	2019.01	07/12/2018 12:57:40 PM Central Daylight Time	06/01/2018 04:17:45 PM Central Daylight Time				07/13/2018 09:02:20 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H1944	030	0	2019	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1944	805	0	1	01	01	H1944_805_0	3	1				05/30/2018	2019.01	05/30/2018 12:44:15 PM Central Daylight Time					06/02/2018 05:27:11 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	805	0	2019	Select counties in MA, PA, RI, VT		1	8592	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1944	806	0	1	01	01	H1944_806_0	3	1				05/30/2018	2019.01	05/30/2018 12:44:32 PM Central Daylight Time					06/02/2018 05:27:11 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	806	0	2019	Select counties in MA, PA, RI, VT		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H1944	807	0	1	01	01	H1944_807_0	3	1				05/30/2018	2019.01	05/30/2018 12:44:44 PM Central Daylight Time					06/02/2018 05:27:11 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	807	0	2019	Select counties in MA, PA, RI, VT		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1951	013	0	1	01	01	H1951_013_0	3	1				07/02/2018	2019.01	07/02/2018 12:05:29 PM Eastern Daylight Time	06/01/2018 03:31:32 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-013 (HMO)	01	01		1			H1951	013	0	2019	Shreveport Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	024	0	1	01	01	H1951_024_0	3	1				07/02/2018	2019.01	07/02/2018 12:05:58 PM Eastern Daylight Time	06/01/2018 03:13:39 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-024 (HMO)	01	01		1			H1951	024	0	2019	Tangipahoa Parish		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	028	0	1	01	01	H1951_028_0	3	1				07/02/2018	2019.01	07/02/2018 12:06:25 PM Eastern Daylight Time	06/01/2018 03:15:07 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-028 (HMO)	01	01		1			H1951	028	0	2019	Washington and St. Tammany Parishes		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	030	0	1	01	01	H1951_030_0	2	1				07/02/2018	2019.01	07/02/2018 12:07:15 PM Eastern Daylight Time	06/01/2018 03:14:40 PM Eastern Daylight Time				07/06/2018 02:26:06 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-030 (HMO)	01	01		1			H1951	030	0	2019	Baton Rouge Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1951	032	0	1	01	01	H1951_032_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:36:48 PM Eastern Daylight Time	07/16/2018 04:03:57 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-032 (HMO SNP)	01	01		1			H1951	032	0	2019	Baton Rouge Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	033	0	1	01	01	H1951_033_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:04:51 PM Eastern Daylight Time	07/16/2018 04:07:39 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-033 (HMO SNP)	01	01		1			H1951	033	0	2019	New Orleans Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	034	0	1	01	01	H1951_034_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:05:55 PM Eastern Daylight Time	07/16/2018 04:33:43 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-034 (HMO SNP)	01	01		1			H1951	034	0	2019	Washington and St. Tammany Parishes		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	038	0	1	01	01	H1951_038_0	4	1				07/02/2018	2019.01	07/02/2018 11:53:26 AM Eastern Daylight Time	06/01/2018 03:18:00 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Total Care Advantage H1951-038 (HMO)	01	01		1			H1951	038	0	2019	New Orleans Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	039	0	1	01	01	H1951_039_0	3	1				07/02/2018	2019.01	07/02/2018 12:08:30 PM Eastern Daylight Time	06/01/2018 03:17:31 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Total Care Advantage H1951-039 (HMO)	01	01		1			H1951	039	0	2019	Baton Rouge Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	041	0	1	01	01	H1951_041_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:07:40 PM Eastern Daylight Time	08/03/2018 12:39:04 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-041 (HMO SNP)	01	01		1			H1951	041	0	2019	Select Louisiana Parishes		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	044	0	1	01	01	H1951_044_0	4	1		1		07/18/2018	2019.01	07/18/2018 05:00:23 PM Eastern Daylight Time	06/01/2018 03:19:26 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H1951	044	0	2019	Jefferson and Orleans Parishes		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	047	1	1	01	01	H1951_047_1	3	1				07/02/2018	2019.01	07/02/2018 11:55:15 AM Eastern Daylight Time	06/01/2018 03:22:57 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-047 (HMO)	01	01		1			H1951	047	1	2019	New Orleans Area	Jefferson, Orleans, and St. Charles Parishes	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	047	2	1	01	01	H1951_047_2	3	1				07/02/2018	2019.01	07/02/2018 11:56:39 AM Eastern Daylight Time	06/01/2018 03:22:27 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-047 (HMO)	01	01		1			H1951	047	2	2019	New Orleans Area	Select Louisiana Parishes	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	048	1	1	01	01	H1951_048_1	3	1				07/02/2018	2019.01	07/02/2018 12:08:56 PM Eastern Daylight Time	06/01/2018 03:21:56 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-048 (HMO)	01	01		1			H1951	048	1	2019	Baton Rouge Area	Baton Rouge Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	048	2	1	01	01	H1951_048_2	3	1				07/02/2018	2019.01	07/02/2018 12:09:18 PM Eastern Daylight Time	06/01/2018 03:21:27 PM Eastern Daylight Time	08/03/2018 09:21:03 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-048 (HMO)	01	01		1			H1951	048	2	2019	Baton Rouge Area	Select Louisiana Parishes	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	049	1	1	01	01	H1951_049_1	3	1				07/02/2018	2019.01	07/02/2018 12:09:45 PM Eastern Daylight Time	06/01/2018 03:24:58 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-049 (HMO)	01	01		1			H1951	049	1	2019	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	049	2	1	01	01	H1951_049_2	3	1				07/02/2018	2019.01	07/02/2018 12:10:11 PM Eastern Daylight Time	06/01/2018 03:27:34 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-049 (HMO)	01	01		1			H1951	049	2	2019	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	049	3	1	01	01	H1951_049_3	3	1				07/02/2018	2019.01	07/02/2018 12:10:50 PM Eastern Daylight Time	06/01/2018 03:28:03 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-049 (HMO)	01	01		1			H1951	049	3	2019	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	801	0	1	01	01	H1951_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:25:02 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1951	801	0	2019	Select parishes in Louisiana		1	83540	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1951	804	0	1	01	01	H1951_804_0	1	1				05/31/2018	2019.01	05/31/2018 12:26:05 PM Eastern Daylight Time					05/31/2018 01:22:35 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1951	804	0	2019	Select parishes in Louisiana		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1961	003	0	1	01	01	H1961_003_0	7	1	2	1		08/07/2018	2019.01	08/07/2018 12:10:36 PM Central Daylight Time	08/06/2018 03:47:54 PM Central Daylight Time	08/06/2018 03:49:10 PM Central Daylight Time			08/07/2018 12:11:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Health (HMO SNP)	01	01		1			H1961	003	0	2019	South Louisiana		2	250743	2			1	3		2		2	www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	011	0	1	01	01	H1961_011_0	5	1	2	1		08/07/2018	2019.01	08/07/2018 02:18:15 PM Central Daylight Time	08/06/2018 03:48:13 PM Central Daylight Time	08/06/2018 03:49:21 PM Central Daylight Time			08/07/2018 02:18:53 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice #011 (HMO SNP)	01	01		1			H1961	011	0	2019	North and Central Louisiana		2	481	2			1	3		2		2	www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	014	1	1	01	01	H1961_014_1	5	1				08/07/2018	2019.01	08/07/2018 12:14:35 PM Central Daylight Time	08/06/2018 03:48:27 PM Central Daylight Time	08/06/2018 03:49:31 PM Central Daylight Time			08/07/2018 02:08:45 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	01	01		1			H1961	014	1	2019	New Orleans Metro Area and Northshore	Southeast Louisiana	2	443209	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	014	2	1	01	01	H1961_014_2	6	1				08/07/2018	2019.01	08/07/2018 12:15:24 PM Central Daylight Time	08/06/2018 03:48:41 PM Central Daylight Time	08/06/2018 03:49:41 PM Central Daylight Time			08/07/2018 02:11:38 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	01	01		1			H1961	014	2	2019	New Orleans Metro Area and Northshore	Northshore	2	85905	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	017	0	1	02	01	H1961_017_0	6	1				08/07/2018	2019.01	08/07/2018 12:00:38 PM Central Daylight Time	08/06/2018 03:48:59 PM Central Daylight Time	08/07/2018 08:37:30 AM Central Daylight Time			08/07/2018 12:06:41 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Gold (HMO-POS)	01	02		1			H1961	017	0	2019	Lafayette and Lake Charles area		2	16037	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	801	0	1	02	01	H1961_801_0	1	1				05/23/2018	2019.01	05/23/2018 03:46:28 PM Central Daylight Time					05/31/2018 03:47:55 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	801	0	2019	Nationwide		1	30945	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	802	0	1	02	01	H1961_802_0	1	1				05/23/2018	2019.01	05/23/2018 03:46:45 PM Central Daylight Time					05/31/2018 03:49:55 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	802	0	2019	Nationwide		1	30945	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	803	0	1	01	01	H1961_803_0	1	1				05/23/2018	2019.01	05/23/2018 03:46:58 PM Central Daylight Time					05/31/2018 03:51:25 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	803	0	2019	Nationwide		1	100	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	804	0	1	01	01	H1961_804_0	1	1				05/23/2018	2019.01	05/23/2018 03:48:15 PM Central Daylight Time					05/31/2018 03:52:47 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	804	0	2019	Nationwide		1	100	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1969	002	0	1	01	01	H1969_002_0	8	1				07/23/2018	2019.01	07/23/2018 09:59:17 AM Mountain Daylight Time	08/01/2018 11:07:45 PM Mountain Daylight Time	08/01/2018 11:08:21 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO (HMO)	01	01		1			H1969	002	0	2019	Ada and Canyon Counties		2	25716	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1969	004	0	1	01	01	H1969_004_0	8	1				07/23/2018	2019.01	07/23/2018 10:19:34 AM Mountain Daylight Time	08/01/2018 11:09:18 PM Mountain Daylight Time	08/01/2018 11:10:00 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO Plus (HMO)	01	01		1			H1969	004	0	2019	Ada and Canyon Counties		2	13362	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1969	801	0	1	01	01	H1969_801_0	1	1				05/17/2018	2019.01	05/17/2018 04:28:19 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO (HMO)	01	01		1			H1969	801	0	2019	Ada and Canyon Counties		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H1969	802	0	1	01	01	H1969_802_0	1	1				05/17/2018	2019.01	05/17/2018 04:28:31 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO 02 (HMO)	01	01		1			H1969	802	0	2019	Ada and Canyon counties		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H1969	803	0	1	01	01	H1969_803_0	1	1				05/17/2018	2019.01	05/17/2018 04:28:40 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO 03 (HMO)	01	01		1			H1969	803	0	2019	Ada and Canyon counties		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H1977	001	0	1	48	05	H1977_001_0	8	1				08/31/2018	2019.01	08/31/2018 02:02:48 PM Eastern Daylight Time					08/31/2018 02:02:57 PM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan (UPHP) MI Health Link	www.uphp.com/medicare	Upper Peninsula Health Plan MI Health Link (Medicare-Medicaid Plan)	05	48		1			H1977	001	0	2019	Upper Peninsula of Michigan		2	55200	2			2						www.uphp.com/pharmacy	www.uphp.com/medicare/uphp-mi-health-link/formulary	www.uphp.com/medicare/providers	(877)349-9324		(877)349-9324		(877)349-9324		(877)349-9324		(855)380-0275		(855)380-0275		(877)349-9324		(877)349-9324		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H1994	001	0	1	01	01	H1994_001_0	6	1				07/13/2018	2019.01	07/13/2018 12:28:09 PM Mountain Daylight Time	08/02/2018 01:52:48 PM Mountain Daylight Time	08/02/2018 02:00:32 PM Mountain Daylight Time			08/07/2018 10:23:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage Essential (HMO)	01	01		1			H1994	001	0	2019	Counties: Dav, Mor, SLC, Sum, Too, Uta, Was, Web		2		2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	002	0	1	01	01	H1994_002_0	5	1				07/13/2018	2019.01	07/13/2018 12:28:48 PM Mountain Daylight Time	08/02/2018 01:53:28 PM Mountain Daylight Time	08/02/2018 02:01:00 PM Mountain Daylight Time			08/07/2018 10:23:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	002	0	2019	Garfield, Iron, Sanpete, Sevier, and Washington Co		2	69338	2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	003	0	1	01	01	H1994_003_0	9	1				07/13/2018	2019.01	07/13/2018 12:33:18 PM Mountain Daylight Time	08/06/2018 03:20:25 PM Mountain Daylight Time	08/06/2018 03:20:27 PM Mountain Daylight Time			08/07/2018 12:45:57 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage Essential (HMO)	01	01		1			H1994	003	0	2019	Southwest Idaho		2		2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(208)429-9900		(855)442-9940		(855)442-9940		(855)442-9900		(208)429-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2	2			
H1994	004	0	1	01	01	H1994_004_0	8	1				07/13/2018	2019.01	07/13/2018 12:34:14 PM Mountain Daylight Time	08/06/2018 03:20:31 PM Mountain Daylight Time	08/06/2018 03:20:32 PM Mountain Daylight Time			08/07/2018 12:45:57 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	004	0	2019	Bla, Cas, Goo, Jer, Min, Twi		2		2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2	2			
H1994	005	0	1	01	01	H1994_005_0	5	1				07/13/2018	2019.01	07/13/2018 12:29:02 PM Mountain Daylight Time	08/02/2018 01:55:22 PM Mountain Daylight Time	08/02/2018 02:02:24 PM Mountain Daylight Time			08/07/2018 10:23:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	005	0	2019	Box Elder, Cache, Franklin, and Rich Counties		2	6214	2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	007	0	1	01	01	H1994_007_0	5	1				07/16/2018	2019.01	07/16/2018 11:02:09 PM Mountain Daylight Time	08/02/2018 01:56:00 PM Mountain Daylight Time	08/02/2018 02:02:52 PM Mountain Daylight Time			08/07/2018 10:23:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage Enhanced (HMO)	01	01		1			H1994	007	0	2019	Counties: Dav, Mor, SLC, Sum, Too, Uta, Was, Web		2	15742	2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	008	0	1	01	01	H1994_008_0	8	1				07/13/2018	2019.01	07/13/2018 12:34:49 PM Mountain Daylight Time	08/06/2018 03:20:43 PM Mountain Daylight Time	08/06/2018 03:20:46 PM Mountain Daylight Time			08/07/2018 12:45:57 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage Enhanced (HMO)	01	01		1			H1994	008	0	2019	Southwest Idaho		2		2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2	2			
H1994	009	0	1	01	01	H1994_009_0	7	1				07/13/2018	2019.01	07/13/2018 01:37:50 PM Mountain Daylight Time	08/02/2018 01:57:18 PM Mountain Daylight Time	08/02/2018 02:03:48 PM Mountain Daylight Time			08/07/2018 10:23:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	selecthealthadvantage.org	SelectHealth Advantage Essential (HMO)	01	01		1			H1994	009	0	2019	Clark County Nevada		2		2			2						selecthealthadvantage.org	selecthealthadvantage.org	selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	010	0	1	01	01	H1994_010_0	6	1		1		07/13/2018	2019.01	07/13/2018 12:29:45 PM Mountain Daylight Time	08/02/2018 01:57:56 PM Mountain Daylight Time	08/02/2018 02:04:16 PM Mountain Daylight Time			08/07/2018 10:23:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	selecthealthadvantage.org	SelectHealth Advantage - Diabetes and Heart Care (HMO SNP)	01	01		1			H1994	010	0	2019	Clark County Nevada		2		2			1	4			00000000000000000010		selecthealthadvantage.org	selecthealthadvantage.org	selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	011	0	1	01	01	H1994_011_0	7	1		1		07/13/2018	2019.01	07/13/2018 12:30:01 PM Mountain Daylight Time	08/02/2018 01:58:34 PM Mountain Daylight Time	08/02/2018 02:04:44 PM Mountain Daylight Time			08/07/2018 10:23:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	selecthealthadvantage.org	SelectHealth Advantage - Lung Care (HMO SNP)	01	01		1			H1994	011	0	2019	Clark County Nevada		2		2			1	4			00000000000100000000		selecthealthadvantage.org	selecthealthadvantage.org	selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	801	0	1	01	01	H1994_801_0	1	1				06/02/2018	2019.01	06/02/2018 12:54:27 PM Mountain Daylight Time					06/04/2018 10:22:46 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	801	0	2019	Utah and Idaho, and Clark County Nevada		1	300	2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1994	802	0	1	01	01	H1994_802_0	1	1				06/02/2018	2019.01	06/02/2018 12:54:32 PM Mountain Daylight Time					06/04/2018 10:22:46 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	802	0	2019	Utah and Idaho, and Clark County Nevada		1	300	2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H1994	803	0	1	01	01	H1994_803_0	1	1				06/02/2018	2019.01	06/02/2018 12:54:39 PM Mountain Daylight Time					06/04/2018 10:22:46 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	803	0	2019	Utah and Idaho, and Clark County Nevada		1	300	2			2						www.selecthealthadvantage.org	www.selecthealthadvantage.org	www.selecthealthadvantage.org	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H1997	002	0	1	01	01	H1997_002_0	8	1				07/23/2018	2019.01	07/23/2018 10:18:13 AM Mountain Daylight Time	08/01/2018 11:10:51 PM Mountain Daylight Time	08/01/2018 11:11:29 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	01	01		1			H1997	002	0	2019	King, Pierce, and Snohomish counties		2	33858	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1997	007	1	1	01	01	H1997_007_1	8	1				07/22/2018	2019.01	07/22/2018 10:49:19 AM Mountain Daylight Time	08/01/2018 11:12:18 PM Mountain Daylight Time	08/01/2018 11:12:56 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H1997	007	1	2019	King, Pierce, Snohomish counties	King and Pierce Counties	2	6846	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1997	007	2	1	01	01	H1997_007_2	8	1				07/22/2018	2019.01	07/22/2018 10:59:19 AM Mountain Daylight Time	08/01/2018 11:13:48 PM Mountain Daylight Time	08/01/2018 11:14:27 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H1997	007	2	2019	King, Pierce, Snohomish counties	Snohomish County	2	5490	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1997	803	0	1	01	01	H1997_803_0	1	1				05/17/2018	2019.01	05/17/2018 04:29:51 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H1997	803	0	2019	King, Pierce, and Snohomish counties		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H1997	804	0	1	01	01	H1997_804_0	1	1				05/17/2018	2019.01	05/17/2018 04:30:02 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO 02 (HMO)	01	01		1			H1997	804	0	2019	King, Pierce, and Snohomish counties		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H1997	805	0	1	01	01	H1997_805_0	1	1				05/17/2018	2019.01	05/17/2018 04:30:11 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO 03 (HMO)	01	01		1			H1997	805	0	2019	King, Pierce, and Snohomish counties		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H2001	001	0	1	04	01	H2001_001_0	3	1				08/02/2018	2019.01	08/02/2018 02:10:10 PM Central Daylight Time	08/03/2018 09:43:38 AM Central Daylight Time	07/31/2018 06:11:24 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H2001	001	0	2019	Southwest Maine		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2001	010	0	1	04	01	H2001_010_0	4	1				07/12/2018	2019.01	07/12/2018 01:00:50 PM Central Daylight Time	08/03/2018 09:44:22 AM Central Daylight Time	07/31/2018 06:11:56 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2001	010	0	2019	Southwest Maine		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2001	017	0	1	04	01	H2001_017_0	3	1				05/24/2018	2019.01	05/24/2018 05:43:42 PM Central Daylight Time	08/03/2018 09:45:05 AM Central Daylight Time	07/31/2018 06:12:18 PM Central Daylight Time			08/07/2018 07:38:26 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (PPO)	01	04		1			H2001	017	0	2019	Washington County		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2001	816	0	1	04	01	H2001_816_0	1	1				05/30/2018	2019.01	05/30/2018 02:07:51 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	816	0	2019	National Service Area		1	5668464	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	817	0	1	04	01	H2001_817_0	1	1				05/30/2018	2019.01	05/30/2018 02:07:35 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	817	0	2019	National Service Area		1	6437460	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2001	818	0	1	04	01	H2001_818_0	1	1				05/30/2018	2019.01	05/30/2018 02:07:12 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	818	0	2019	National Service Area		1	26076	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	819	0	2	04	01	H2001_819_0	1	1				05/30/2018	2019.01	05/30/2018 02:10:16 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	819	0	2019	National Service Area		1	10344	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	820	0	2	04	01	H2001_820_0	1	1				05/30/2018	2019.01	05/30/2018 02:12:50 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	820	0	2019	National Service Area		1	28176	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2001	821	0	2	04	01	H2001_821_0	1	1				05/30/2018	2019.01	05/30/2018 02:14:58 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	821	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	822	0	1	04	01	H2001_822_0	1	1				05/30/2018	2019.01	05/30/2018 02:16:52 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	822	0	2019	Select Counties		1	4176	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	823	0	1	04	01	H2001_823_0	1	1				05/30/2018	2019.01	05/30/2018 02:19:47 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	823	0	2019	Select Counties		1	720	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2001	824	0	1	04	01	H2001_824_0	1	1				05/30/2018	2019.01	05/30/2018 02:21:32 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	824	0	2019	Select Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	825	0	1	04	01	H2001_825_0	1	1				05/30/2018	2019.01	05/30/2018 02:23:06 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	825	0	2019	Select Counties		1	45420	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	826	0	1	04	01	H2001_826_0	1	1				05/30/2018	2019.01	05/30/2018 02:25:10 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	826	0	2019	Select Counties		1	46692	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	827	0	1	04	01	H2001_827_0	1	1				05/30/2018	2019.01	05/30/2018 02:26:55 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	827	0	2019	National Service Area		1	1729788	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	828	0	1	04	01	H2001_828_0	1	1				05/30/2018	2019.01	05/30/2018 02:28:44 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	828	0	2019	National Service Area		1	278304	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	829	0	1	04	01	H2001_829_0	1	1				05/30/2018	2019.01	05/30/2018 02:30:28 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	829	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	830	0	1	04	01	H2001_830_0	1	1				05/30/2018	2019.01	05/30/2018 02:31:59 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	830	0	2019	National Service Area		1	516	2			2						9999	www.UHCMedicareSolutions.com	610494	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2001	831	0	1	04	01	H2001_831_0	1	1				05/30/2018	2019.01	05/30/2018 02:33:27 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	831	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	832	0	2	04	01	H2001_832_0	1	1				05/30/2018	2019.01	05/30/2018 02:35:04 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	832	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	833	0	2	04	01	H2001_833_0	1	1				05/30/2018	2019.01	05/30/2018 02:36:25 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	833	0	2019	National Service Area		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2001	834	0	2	04	01	H2001_834_0	1	1				05/30/2018	2019.01	05/30/2018 02:38:28 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	834	0	2019	National Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	835	0	1	04	01	H2001_835_0	1	1				05/30/2018	2019.01	05/30/2018 02:40:09 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	835	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	836	0	1	04	01	H2001_836_0	1	1				05/30/2018	2019.01	05/30/2018 02:41:44 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	836	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	837	0	1	04	01	H2001_837_0	1	1				05/30/2018	2019.01	05/30/2018 02:43:14 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	837	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	838	0	1	04	01	H2001_838_0	1	1				05/30/2018	2019.01	05/30/2018 02:45:22 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	838	0	2019	Nationwide		1	607176	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	839	0	2	04	01	H2001_839_0	1	1				05/30/2018	2019.01	05/30/2018 02:47:29 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	839	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	840	0	1	04	01	H2001_840_0	1	1				05/30/2018	2019.01	05/30/2018 03:09:50 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	840	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2001	841	0	1	04	01	H2001_841_0	1	1				05/30/2018	2019.01	05/30/2018 03:11:11 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	841	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	842	0	1	04	01	H2001_842_0	1	1				05/30/2018	2019.01	05/30/2018 03:12:48 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	842	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	843	0	1	04	01	H2001_843_0	1	1				05/30/2018	2019.01	05/30/2018 03:14:29 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	843	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	844	0	1	04	01	H2001_844_0	1	1				05/30/2018	2019.01	05/30/2018 03:16:11 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	844	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2001	845	0	1	04	01	H2001_845_0	1	1				05/30/2018	2019.01	05/30/2018 03:18:05 PM Central Daylight Time					06/02/2018 03:02:51 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	845	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2011	001	0	1	01	01	H2011_001_0	11	1				07/06/2018	2019.01	07/06/2018 12:45:01 PM Central Daylight Time	08/02/2018 01:21:56 PM Central Daylight Time	08/02/2018 11:05:30 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage (HMO)	01	01		1			H2011	001	0	2019	Davidson, Rutherford, and Williamson Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2011	002	0	1	01	01	H2011_002_0	11	1				07/06/2018	2019.01	07/06/2018 12:45:10 PM Central Daylight Time	08/02/2018 01:23:28 PM Central Daylight Time	08/02/2018 11:06:10 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Plus (HMO)	01	01		1			H2011	002	0	2019	Davidson, Rutherford, and Williamson Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2020	001	0	1	04	01	H2020_001_0	7	1				07/06/2018	2019.01	07/06/2018 03:17:54 PM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	01	04		1			H2020	001	0	2019	North Central CO		2	19419	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(180)000-0000				(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		2					2						2			
H2020	002	0	1	04	01	H2020_002_0	7	1				06/07/2018	2019.01	06/07/2018 11:25:00 AM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	01	04		1			H2020	002	0	2019	Southeast VA		2	24660	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(180)000-0000				(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		2					2						2			
H2020	003	0	1	04	01	H2020_003_0	7	1				06/07/2018	2019.01	06/07/2018 11:25:12 AM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	01	04		1			H2020	003	0	2019	Robeson and Scotland Counties		2	10789	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(180)000-0000				(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		2					2						2			
H2020	004	0	1	04	01	H2020_004_0	7	1				06/07/2018	2019.01	06/07/2018 11:25:27 AM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (PPO)	01	04		1			H2020	004	0	2019	North Central Colorado		2	8323	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(800)000-0000				(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		2					2						2			
H2020	005	0	1	04	01	H2020_005_0	7	1				06/07/2018	2019.01	06/07/2018 11:25:40 AM Central Daylight Time	08/06/2018 02:12:11 PM Central Daylight Time	08/06/2018 02:12:12 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (PPO)	01	04		1			H2020	005	0	2019	Robeson and Scotland Counties		2	4624	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(800)000-0000				(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		2					2						2			
H2029	001	0	1	04	01	H2029_001_0	5	1				07/03/2018	2019.01	07/03/2018 03:31:50 PM Eastern Daylight Time	07/18/2018 01:56:08 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	HumanaChoice Value H2029-001 (PPO)	01	04		1			H2029	001	0	2019	Puerto Rico Island Wide		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2029	801	0	1	04	01	H2029_801_0	1	1				05/31/2018	2019.01	05/31/2018 11:13:35 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	801	0	2019	Puerto Rico - Island Wide		1	1341	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	802	0	1	04	01	H2029_802_0	1	1				05/31/2018	2019.01	05/31/2018 11:14:58 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	802	0	2019	Puerto Rico - Island Wide		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	803	0	1	04	01	H2029_803_0	1	1				05/31/2018	2019.01	05/31/2018 11:15:20 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		1			H2029	803	0	2019	Puerto Rico - Island Wide		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	805	0	2	04	01	H2029_805_0	1	1				05/31/2018	2019.01	05/31/2018 11:15:40 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H2029	805	0	2019	Puerto Rico - Island Wide		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	806	0	2	04	01	H2029_806_0	1	1				05/31/2018	2019.01	05/31/2018 11:16:15 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H2029	806	0	2019	Puerto Rico - Island Wide		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	807	0	2	04	01	H2029_807_0	1	1				05/31/2018	2019.01	05/31/2018 11:17:57 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H2029	807	0	2019	Puerto Rico - Island Wide		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2032	001	0	1	04	01	H2032_001_0	5	1				05/31/2018	2019.01	05/31/2018 01:59:08 PM Central Daylight Time	08/06/2018 03:12:12 PM Central Daylight Time	08/02/2018 08:13:58 AM Central Daylight Time			08/07/2018 08:25:30 AM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage (PPO)	01	04		1			H2032	001	0	2019	Dallas/Ft. Worth Metro Area		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2032	002	0	1	04	01	H2032_002_0	5	1				06/04/2018	2019.01	06/04/2018 01:06:21 PM Central Daylight Time	08/06/2018 03:14:10 PM Central Daylight Time	08/02/2018 08:16:40 AM Central Daylight Time			08/07/2018 08:25:30 AM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Basic (PPO)	01	04		1			H2032	002	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2032	003	0	1	04	01	H2032_003_0	5	1				05/31/2018	2019.01	05/31/2018 12:13:20 PM Central Daylight Time	08/06/2018 03:15:58 PM Central Daylight Time	08/02/2018 09:47:48 AM Central Daylight Time			08/07/2018 08:25:30 AM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Platinum (PPO)	01	04		1			H2032	003	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2034	001	0	1	01	01	H2034_001_0	7	1	2	1		08/13/2018	2019.01	08/13/2018 03:01:25 PM Central Daylight Time	08/07/2018 02:06:21 PM Central Daylight Time	08/07/2018 02:05:12 PM Central Daylight Time			08/13/2018 03:17:23 PM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's  Partnership Program (HMO SNP)	01	01		1			H2034	001	0	2019	Eastern Wisconsin		2	4558	2			1	3		1		1	www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org	(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2034	002	0	1	01	01	H2034_002_0	7	1	2	1		08/13/2018	2019.01	08/13/2018 03:02:18 PM Central Daylight Time	08/07/2018 02:07:03 PM Central Daylight Time	08/07/2018 02:06:07 PM Central Daylight Time			08/13/2018 03:17:23 PM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's Partnership Program Disabled (HMO SNP)	01	01		1			H2034	002	0	2019	Eastern Wisconsin		2	1261	2			1	3		1		1	www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org	(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2064	001	0	1	20	08	H2064_001_0	3	1				06/04/2018	2019.01	06/04/2018 11:37:08 AM Eastern Daylight Time		06/04/2018 11:29:56 AM Eastern Daylight Time			06/04/2018 11:57:46 AM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	001	0	2019	LIFE Geisinger		2		2			2						www.lifegeisinger.org	www.lifegeisinger.org										(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790										(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790																
H2064	002	0	1	20	08	H2064_002_0	3	1				06/01/2018	2019.01	06/01/2018 05:48:16 PM Eastern Daylight Time		06/04/2018 11:29:36 AM Eastern Daylight Time			06/04/2018 11:57:46 AM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	002	0	2019	LIFE Geisinger		2		2			2						www.lifegeisinger.org	www.lifegeisinger.org										(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790										(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790																
H2108	001	0	1	01	01	H2108_001_0	4	1	2	1		05/27/2018	2019.01	05/27/2018 08:58:39 PM Central Daylight Time	08/03/2018 08:42:41 AM Central Daylight Time	07/31/2018 08:14:22 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H2108	001	0	2019	Maryland, Washington DC and Delaware Counties		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	020	0	1	01	01	H2108_020_0	4	1		1		08/02/2018	2019.01	08/02/2018 05:29:29 PM Central Daylight Time	08/03/2018 08:43:03 AM Central Daylight Time	07/31/2018 08:14:36 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Traditions (HMO SNP)	01	01		1			H2108	020	0	2019	Maryland, Washington DC, and Delaware Counties		2		2			1	1	1				www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	022	0	1	01	01	H2108_022_0	5	1				05/30/2018	2019.01	05/30/2018 09:36:58 AM Central Daylight Time	08/03/2018 08:43:24 AM Central Daylight Time	07/31/2018 08:18:44 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2108	022	0	2019	Select Maryland Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	028	0	1	01	01	H2108_028_0	4	1				08/02/2018	2019.01	08/02/2018 05:30:01 PM Central Daylight Time	08/03/2018 08:43:46 AM Central Daylight Time	07/31/2018 08:18:57 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2108	028	0	2019	Maryland, Washington DC and Delaware Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	029	0	1	01	01	H2108_029_0	4	1		1		08/02/2018	2019.01	08/02/2018 05:30:35 PM Central Daylight Time	08/03/2018 08:44:07 AM Central Daylight Time	07/31/2018 08:19:11 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H2108	029	0	2019	Maryland, Washington DC and Delaware Counties		2		2			1	4			00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	030	0	1	01	01	H2108_030_0	4	1		1		05/27/2018	2019.01	05/27/2018 09:27:08 PM Central Daylight Time	08/03/2018 08:44:29 AM Central Daylight Time	07/31/2018 08:19:24 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H2108	030	0	2019	Select Maryland Counties		2		2			1	4			00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	032	0	1	01	01	H2108_032_0	4	1				08/02/2018	2019.01	08/02/2018 05:30:48 PM Central Daylight Time	08/03/2018 08:44:51 AM Central Daylight Time	07/31/2018 08:19:38 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreventiveCare (HMO)	01	01		1			H2108	032	0	2019	Maryland, Washington DC, and Delaware Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	033	0	1	01	01	H2108_033_0	4	1				05/27/2018	2019.01	05/27/2018 09:38:44 PM Central Daylight Time	08/03/2018 08:45:14 AM Central Daylight Time	07/31/2018 08:19:51 PM Central Daylight Time			08/06/2018 11:28:49 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreventiveCare (HMO)	01	01		1			H2108	033	0	2019	Select Maryland Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	801	0	1	01	01	H2108_801_0	2	1				05/22/2018	2019.01	05/22/2018 02:05:11 PM Central Daylight Time					05/31/2018 12:54:24 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H2108	801	0	2019	Statewide MD, DC and DE		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14e1;15;16b;17a;	1	1a;3-1;3-2;3-3;7b;7d;7f;9a1;9a2;12;14e3;	1					1				
H2108	807	0	1	02	01	H2108_807_0	2	1				05/22/2018	2019.01	05/22/2018 02:04:46 PM Central Daylight Time					05/31/2018 12:54:24 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H2108	807	0	2019	Statewide MD, DC & DE		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14e1;15;16b;17a;	1	1a;3-1;3-2;3-3;7b;7d;7f;9a1;9a2;12;14e3;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14e1;15;16b;17a;	2		1				
H2109	001	0	1	20	08	H2109_001_0	1	1				05/16/2018	2019.01	05/16/2018 12:17:53 PM Eastern Daylight Time		05/16/2018 12:08:41 PM Eastern Daylight Time			05/16/2018 12:24:04 PM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation. (PACE)	08	20		1			H2109	001	0	2019	Parts of Baltimore City and County, Maryland		2	1830	2			2						http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus												(410)550-7044				(410)550-7044												(410)550-0316				(410)550-0316																
H2109	002	0	1	20	08	H2109_002_0	1	1				05/16/2018	2019.01	05/16/2018 12:18:26 PM Eastern Daylight Time		05/16/2018 12:08:42 PM Eastern Daylight Time			05/16/2018 12:24:04 PM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation (PACE)	08	20		1			H2109	002	0	2019	Parts of Baltimore City and County, Maryland		2	24	2			2						http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus												(410)550-7044				(410)550-7044												(410)550-0316				(410)550-0316																
H2134	001	0	1	01	01	H2134_001_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 06:36:50 PM Eastern Daylight Time	08/05/2018 07:50:38 PM Eastern Daylight Time	08/03/2018 07:51:44 PM Eastern Daylight Time			08/06/2018 07:38:25 AM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Allwell	allwell.westernskycommunity.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H2134	001	0	2019	Bernalillo, Cibola, Sandoval, Valencia		2		2			1	3		1		1	allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor			(888)888-8888				(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		2					2					2	2			
H2134	801	0	1	01	01	H2134_801_0	3	1				05/29/2018	2019.01	05/29/2018 04:36:44 PM Pacific Daylight Time					06/04/2018 03:55:19 PM Pacific Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	801	0	2019	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor			(888)888-8888				(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2134	802	0	1	01	01	H2134_802_0	3	1				05/29/2018	2019.01	05/29/2018 04:36:52 PM Pacific Daylight Time					06/04/2018 03:55:19 PM Pacific Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	802	0	2019	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor			(888)888-8888				(888)888-8888										(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2134	803	0	1	01	01	H2134_803_0	3	1				05/29/2018	2019.01	05/29/2018 05:27:39 PM Pacific Daylight Time					06/04/2018 03:55:19 PM Pacific Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	803	0	2019	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor			(888)888-8888				(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		(888)888-8888		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2150	002	0	1	18	06	H2150_002_0	9	1				08/01/2018	2019.01	08/01/2018 10:10:47 AM Eastern Daylight Time		07/31/2018 06:44:19 PM Eastern Daylight Time			08/03/2018 09:55:56 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus High w/Part D (AB) (Cost)	06	18		1			H2150	002	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	77161	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	009	0	1	18	06	H2150_009_0	9	1				08/01/2018	2019.01	08/01/2018 10:11:10 AM Eastern Daylight Time		07/31/2018 06:49:10 PM Eastern Daylight Time			08/03/2018 09:55:56 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost)	06	18		1			H2150	009	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	123558	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	017	0	1	18	06	H2150_017_0	6	1				07/06/2018	2019.01	07/06/2018 08:59:19 AM Eastern Daylight Time					07/11/2018 11:22:28 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/o D (AB) (Cost)	06	18		1			H2150	017	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	1469	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	021	0	1	18	06	H2150_021_0	6	1				07/05/2018	2019.01	07/05/2018 02:52:22 PM Eastern Daylight Time					07/11/2018 11:22:28 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus High w/o D (AB) (Cost)	06	18		1			H2150	021	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	2214	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	022	0	1	18	06	H2150_022_0	6	1				07/05/2018	2019.01	07/05/2018 02:52:44 PM Eastern Daylight Time					07/11/2018 11:22:28 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/o D (AB) (Cost)	06	18		1			H2150	022	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	7084	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	029	0	2	18	06	H2150_029_0	9	1				08/01/2018	2019.01	08/01/2018 10:11:39 AM Eastern Daylight Time		07/31/2018 06:51:40 PM Eastern Daylight Time			08/03/2018 09:55:56 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/Part D (B) (Cost)	06	18		2	1		H2150	029	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	238	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	030	0	2	18	06	H2150_030_0	6	1				07/06/2018	2019.01	07/06/2018 08:59:41 AM Eastern Daylight Time					07/11/2018 11:22:28 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/o D (B) (Cost)	06	18		2	1		H2150	030	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	19	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	033	0	1	18	06	H2150_033_0	9	1				08/01/2018	2019.01	08/01/2018 10:12:04 AM Eastern Daylight Time		07/31/2018 06:54:36 PM Eastern Daylight Time			08/03/2018 09:55:56 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/D (AB) (Cost)	06	18		1			H2150	033	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	1005	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	034	0	2	18	06	H2150_034_0	8	1				08/01/2018	2019.01	08/01/2018 10:12:30 AM Eastern Daylight Time		07/31/2018 06:57:02 PM Eastern Daylight Time			08/03/2018 09:55:56 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/D (B) (Cost)	06	18		2	1		H2150	034	0	2019	Northern VA Area and MD Counties: CV, CR, CH, FR		2	147	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	801	0	1	18	06	H2150_801_0	5	1				06/01/2018	2019.01	06/01/2018 09:15:13 PM Eastern Daylight Time					06/04/2018 03:44:14 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus GRP w/Part D (AB) (Cost)	06	18		1			H2150	801	0	2019	Northern VA Area and MD Counties: CV, CR, FR		1	62310	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2150	805	0	2	18	06	H2150_805_0	5	1				06/01/2018	2019.01	06/01/2018 09:15:21 PM Eastern Daylight Time					06/04/2018 03:44:14 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus GRP w/Part D (B) (Cost)	06	18		2	1		H2150	805	0	2019	Northern VA Area and MD Counties: CV, CR, FR		1	360	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2150	806	0	1	18	06	H2150_806_0	5	1				06/01/2018	2019.01	06/01/2018 09:15:29 PM Eastern Daylight Time					06/04/2018 03:44:14 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus FED w/Part D (AB) (Cost)	06	18		1			H2150	806	0	2019	Northern VA Area and MD Counties: CV, CR, FR		1	42220	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2150	807	0	2	18	06	H2150_807_0	5	1				06/01/2018	2019.01	06/01/2018 09:15:37 PM Eastern Daylight Time					06/04/2018 03:44:14 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus FED w/Part D (B) (Cost)	06	18		2	1		H2150	807	0	2019	Northern VA Area and MD Counties: CV, CR, FR		1	490	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2161	002	0	1	01	01	H2161_002_0	4	1				06/27/2018	2019.01	06/27/2018 08:59:37 AM Eastern Daylight Time	08/06/2018 05:39:34 PM Eastern Daylight Time	08/06/2018 05:39:36 PM Eastern Daylight Time			08/06/2018 05:41:29 PM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Advantage (HMO)	01	01		1			H2161	002	0	2019	Upper Peninsula of Michigan		2	3600	2			2						www.uphp.com/pharmacy	www.uphp.com/medicare/upper-peninsula-health-plan-advantage/formulary-advantage/	www.uphp.com/medicare/providers	(877)349-9324		(877)349-9324		(877)349-9324		(877)349-9324		(844)827-0182		(844)827-0182		(877)349-9324		(877)349-9324		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2161	003	0	1	01	01	H2161_003_0	4	1				06/27/2018	2019.01	06/27/2018 09:03:18 AM Eastern Daylight Time	08/06/2018 05:39:37 PM Eastern Daylight Time	08/06/2018 05:39:38 PM Eastern Daylight Time			08/06/2018 05:46:16 PM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Choice (HMO)	01	01		1			H2161	003	0	2019	Upper Peninsula of Michigan		2	8400	2			2						www.uphp.com/pharmacy	www.uphp.com/medicare/upper-peninsula-health-plan-choice/formulary-choice	www.uphp.com/medicare/providers	(877)349-9324		(877)349-9324		(877)349-9324		(877)349-9324		(844)827-0182		(844)827-0182		(877)349-9324		(877)349-9324		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2168	001	0	1	01	01	H2168_001_0	5	1	2	1		06/01/2018	2019.01	06/01/2018 08:30:37 PM Eastern Daylight Time	08/08/2018 10:19:33 AM Eastern Daylight Time	08/03/2018 05:10:24 PM Eastern Daylight Time			08/08/2018 10:45:28 AM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Health Advantage (HMO SNP)	01	01		1			H2168	001	0	2019	Bronx, Kings, New York, Queens		2		2			1	3		2		1	www.villagecaremax.org	www.villagecaremax.org	www.villagecaremax.org	(800)469-6292		(800)469-6292		(800)469-6292		(800)469-6292		(888)807-6806		(888)807-6806		(800)469-6292		(800)469-6292		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2168	002	0	1	01	01	H2168_002_0	5	1	2	1		06/01/2018	2019.01	06/01/2018 08:30:58 PM Eastern Daylight Time	08/03/2018 05:10:24 PM Eastern Daylight Time	08/03/2018 05:10:24 PM Eastern Daylight Time			08/03/2018 05:18:49 PM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Total Advantage (HMO SNP)	01	01		1			H2168	002	0	2019	Bronx, Kings, New York, Queens		2		2			1	3		1		1	www.villagecaremax.org	www.villagecaremax.org	www.villagecaremax.org	(800)469-6292		(800)469-6292		(800)469-6292		(800)469-6292		(888)807-6806		(888)807-6806		(800)469-6292		(800)469-6292		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2171	001	0	1	01	01	H2171_001_0	5	1				07/20/2018	2019.01	07/20/2018 02:25:07 PM Eastern Daylight Time	08/02/2018 01:10:16 PM Eastern Daylight Time	08/06/2018 12:40:37 PM Eastern Daylight Time			08/06/2018 02:53:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic (HMO)	01	01		1			H2171	001	0	2019	Dallas Fort Worth Metro Area		2	25600	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2171	801	0	1	01	01	H2171_801_0	1	1				04/17/2018	2019.01	04/17/2018 11:53:43 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic CY - MAPD (HMO)	01	01		1			H2171	801	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2171	802	0	1	01	01	H2171_802_0	1	1				04/17/2018	2019.01	04/17/2018 11:53:50 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic NCY - MAPD (HMO)	01	01		1			H2171	802	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2171	803	0	1	01	01	H2171_803_0	1	1				04/17/2018	2019.01	04/17/2018 11:53:56 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic CY - MA-Only (HMO)	01	01		1			H2171	803	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2171	804	0	1	01	01	H2171_804_0	1	1				04/17/2018	2019.01	04/17/2018 11:54:04 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic NCY - MA-Only (HMO)	01	01		1			H2171	804	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2172	001	0	1	01	01	H2172_001_0	7	1				08/02/2018	2019.01	08/02/2018 09:10:21 AM Eastern Daylight Time	08/01/2018 03:17:57 PM Eastern Daylight Time	08/01/2018 03:56:32 PM Eastern Daylight Time			08/06/2018 11:26:18 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High DC (HMO)	01	01		1			H2172	001	0	2019	DC		2	16752	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2172	002	0	1	01	01	H2172_002_0	7	1				08/02/2018	2019.01	08/02/2018 09:10:56 AM Eastern Daylight Time	08/01/2018 03:41:22 PM Eastern Daylight Time	08/01/2018 04:01:26 PM Eastern Daylight Time			08/06/2018 11:26:18 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High MD (HMO)	01	01		1			H2172	002	0	2019	MD Counties: AA, BA, BC, CH, HA, HO, MO, PG		2	110087	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2172	003	0	1	01	01	H2172_003_0	7	1				08/02/2018	2019.01	08/02/2018 09:11:34 AM Eastern Daylight Time	08/01/2018 03:31:15 PM Eastern Daylight Time	08/01/2018 03:59:00 PM Eastern Daylight Time			08/06/2018 11:26:18 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard DC (HMO)	01	01		1			H2172	003	0	2019	DC		2	21027	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2172	004	0	1	01	01	H2172_004_0	7	1				08/02/2018	2019.01	08/02/2018 09:11:57 AM Eastern Daylight Time	08/01/2018 03:47:06 PM Eastern Daylight Time	08/01/2018 04:04:02 PM Eastern Daylight Time			08/06/2018 11:26:18 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard MD (HMO)	01	01		1			H2172	004	0	2019	MD Counties: AA, BA, BC, CH, HA, HO, MO, PG		2	248347	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2172	005	0	1	01	01	H2172_005_0	8	1				07/05/2018	2019.01	07/05/2018 02:56:03 PM Eastern Daylight Time	07/13/2018 01:53:26 PM Eastern Daylight Time				07/23/2018 10:00:23 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage w/o Part D (HMO)	01	01		1			H2172	005	0	2019	DC, MD Counties: AA, BA, BC, CH, HA, HO, MO, PG		2	6033	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2172	006	0	1	01	01	H2172_006_0	9	1				08/02/2018	2019.01	08/02/2018 09:12:24 AM Eastern Daylight Time	08/01/2018 03:09:29 PM Eastern Daylight Time	08/01/2018 04:06:50 PM Eastern Daylight Time			08/06/2018 11:26:18 AM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value (HMO)	01	01		1			H2172	006	0	2019	Baltimore City and Baltimore County		2	25005	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2172	801	0	1	01	01	H2172_801_0	4	1				06/01/2018	2019.01	06/01/2018 09:16:34 PM Eastern Daylight Time					06/04/2018 03:49:03 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage for Groups (HMO)	01	01		1			H2172	801	0	2019	DC and MD Counties: AA, BA, BC, CH, HA, HO, MO, PG		1	102060	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2172	803	0	1	01	01	H2172_803_0	4	1				06/01/2018	2019.01	06/01/2018 09:16:42 PM Eastern Daylight Time					06/04/2018 03:49:03 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Fed w/Part D (HMO)	01	01		1			H2172	803	0	2019	DC and MD Counties: AA, BA, BC, CH, HA, HO, MO, PG		1	105420	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2172	804	0	2	01	01	H2172_804_0	4	1				06/01/2018	2019.01	06/01/2018 09:16:51 PM Eastern Daylight Time					06/04/2018 03:49:03 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Fed B/D (HMO)	01	01		2	1		H2172	804	0	2019	DC and MD Counties: AA, BA, BC, CH, HA, HO, MO, PG		1	1230	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2172	805	0	1	01	01	H2172_805_0	4	1				06/01/2018	2019.01	06/01/2018 09:16:59 PM Eastern Daylight Time					06/04/2018 03:49:03 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage GRP w/o D (HMO)	01	01		1			H2172	805	0	2019	DC and MD Counties: AA, BA, BC, CH, HA, HO, MO, PG		1	9600	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2174	001	0	1	01	01	H2174_001_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 03:41:25 PM Pacific Daylight Time	08/03/2018 05:46:08 PM Pacific Daylight Time	08/03/2018 05:47:37 PM Pacific Daylight Time			08/03/2018 06:43:58 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Medicare Advantage	www.trilliumadvantage.com	Trillium Advantage Dual (HMO SNP)	01	01		1			H2174	001	0	2019	Lane County		2		2			1	3		2		2	www.trilliumadvantage.com/findadoctor	www.trilliumadvantage.com/formulary	www.trilliumadvantage.com/findadoctor	(844)867-1156		(844)867-1156		(877)826-5519		(877)826-5519		(844)867-1156		(844)867-1156		(877)826-5519		(877)826-5519		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2185	001	0	1	01	01	H2185_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:11:20 AM Eastern Daylight Time	08/07/2018 02:52:01 PM Eastern Daylight Time	08/07/2018 02:52:01 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	LIFEWORKS ADVANTAGE, LLC	LifeWorks Advantage (HMO SNP)	www.lifeworksadvantage.com	LifeWorks Advantage I-SNP (HMO SNP)	01	01		1			H2185	001	0	2019	Western and Central Virginia		2	7300	2			1	1	1				www.lifeworksadvantage.com	www.lifeworksadvantage.com	www.lifeworksadvantage.com	(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2218	001	0	1	20	08	H2218_001_0	1	1				06/04/2018	2019.01	06/04/2018 03:31:02 PM Eastern Daylight Time		06/04/2018 02:07:40 PM Eastern Daylight Time			06/04/2018 03:33:54 PM Eastern Daylight Time	HARBOR HEALTH SERVICES, INC.	Elder Service Plan of Harbor Health Services, Inc	www.elderserviceplan.org	Harbor Health Elder Service Plan, Dual Eligible (PACE)	08	20		1			H2218	001	0	2019	Norfolk, Suffolk, Plymouth, and Middlesex Counties		2		2			2						www.eatonapothecary.com	www.elderserviceplan.org												(617)533-2400				(617)533-2400												(617)533-2404				(617)533-2404																
H2218	002	0	1	20	08	H2218_002_0	2	1				06/04/2018	2019.01	06/04/2018 06:53:53 PM Eastern Daylight Time		06/04/2018 02:11:37 PM Eastern Daylight Time			06/04/2018 06:56:16 PM Eastern Daylight Time	HARBOR HEALTH SERVICES, INC.	Elder Service Plan of Harbor Health Services, Inc	www.elderserviceplan.org	Harbor Health Elder Service Plan, Medicare only (PACE)	08	20		1			H2218	002	0	2019	Norfolk, Suffolk, Middlesex, and Plymouth Counties		2		2			2						www.eatonapothecary.com	www.elderserviceplan.org												(617)533-2400				(617)533-2400												(617)533-2404				(617)533-2404																
H2219	001	0	1	20	08	H2219_001_0	1	1				06/01/2018	2019.01	06/01/2018 02:09:39 PM Eastern Daylight Time		06/04/2018 03:51:30 PM Eastern Daylight Time			06/04/2018 04:14:53 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.fallonhealth.org/summit	Summit ElderCare (PACE)	08	20		1			H2219	001	0	2019	Full: Worc,Hampden Part: Essex,Hampshire,Middlesex		2	15482	2			2						Not Applicable	Not Applicable										(800)698-7566		(508)368-9690		(800)698-7566		(508)368-9690										(711)-		(711)-		(711)-		(711)-																
H2219	002	0	1	20	08	H2219_002_0	1	1				05/10/2018	2019.01	05/10/2018 05:38:17 PM Eastern Daylight Time		06/04/2018 03:51:20 PM Eastern Daylight Time			06/04/2018 04:14:53 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.fallonhealth.org/summit	Summit ElderCare (PACE)	08	20		1			H2219	002	0	2019	Full: Worc,Hampden Part: Essex,Hampshire,Middlesex		2	127	2			2						Not Applicable	Not Applicable										(800)698-7566		(508)368-9690		(800)698-7566		(508)368-9690										(711)-		(711)-		(711)-		(711)-																
H2220	001	0	1	20	08	H2220_001_0	1	1				05/30/2018	2019.01	05/30/2018 11:13:29 AM Eastern Daylight Time		05/30/2018 10:22:58 AM Eastern Daylight Time			05/30/2018 11:16:28 AM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Upham's Corner Health Committee (PACE)	08	20		1			H2220	001	0	2019	Upham's Elder Service Plan, inner city of Boston		2		2			2						http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/										(617)288-0970		(617)288-0970		(617)288-0970		(617)288-0970										(617)287-8000		(617)287-8000		(617)287-8000		(617)287-8000																
H2220	002	0	1	20	08	H2220_002_0	2	1				05/30/2018	2019.01	05/30/2018 11:56:22 AM Eastern Daylight Time		05/30/2018 11:55:20 AM Eastern Daylight Time			05/30/2018 11:56:42 AM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Uphams Corner Health Committee (PACE)	08	20		1			H2220	002	0	2019	Upham's Elder Service Plan, inner city of Boston		2		2			2						http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/										(617)288-0970		(617)288-0970		(617)288-0970		(617)288-0970										(617)287-8000		(617)287-8000		(617)287-8000		(617)287-8000																
H2221	001	0	1	20	08	H2221_001_0	1	1				05/30/2018	2019.01	05/30/2018 12:00:00 PM Eastern Daylight Time		05/30/2018 11:47:32 AM Eastern Daylight Time			05/30/2018 12:08:29 PM Eastern Daylight Time	CAMBRIDGE PUBLIC HEALTH COMMISSION	Elder Service Plan of Cambridge Health Alliance	http://www.challiance.org/esp/elder-service-plan.a	Cambridge Public Health Commission (PACE)	08	20		1			H2221	001	0	2019	Counties: Middlesex and Suffolk		2		2			2						http://www.challiance.org/Services/Pharmacy.aspx	none												(617)575-5850		(617)575-5850		(617)575-5850										(800)439-2370		(711)-		(617)575-5850		(617)575-5850																
H2221	002	0	1	20	08	H2221_002_0	1	1				05/30/2018	2019.01	05/30/2018 12:00:33 PM Eastern Daylight Time		05/30/2018 11:47:08 AM Eastern Daylight Time			05/30/2018 12:08:29 PM Eastern Daylight Time	CAMBRIDGE PUBLIC HEALTH COMMISSION	Elder Service Plan of Cambridge Health Alliance	http://www.challiance.org/esp	Cambridge Public Health Commission (PACE)	08	20		1			H2221	002	0	2019	Counties:  Middlesex and Suffolk		2		2			2						http://www.challiance.org/Services/Pharmacy.aspx	none												(617)575-5850		(617)575-5850		(617)575-5850												(711)-		(617)575-5850		(617)575-5850																
H2222	002	0	1	20	08	H2222_002_0	1	1				05/30/2018	2019.01	05/30/2018 10:07:41 AM Eastern Daylight Time		05/30/2018 09:46:59 AM Eastern Daylight Time			05/31/2018 09:04:02 AM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	002	0	2019	Essex, Middlesex counties		2	11943	1	1		2						www.eatonapothecary.com	None										(877)803-5564		(781)715-6608		(877)803-5564		(781)715-6608										(711)-		(711)-		(711)-		(711)-																
H2222	003	0	1	20	08	H2222_003_0	1	1				05/30/2018	2019.01	05/30/2018 10:07:10 AM Eastern Daylight Time		05/30/2018 09:46:59 AM Eastern Daylight Time			05/31/2018 09:04:02 AM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	003	0	2019	Essex, Middlesex counties		2	12	1	1		2						www.eatonapothecary.com	None										(877)803-5564		(781)715-6608		(877)803-5564		(781)715-6608										(711)-		(711)-		(711)-		(711)-																
H2223	001	0	1	20	08	H2223_001_0	1	1				05/21/2018	2019.01	05/21/2018 11:36:28 AM Eastern Daylight Time		05/21/2018 11:27:21 AM Eastern Daylight Time			05/21/2018 11:38:55 AM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Neighborhood PACE	www.ebnhc.org/elderservice.php	East Boston Elder Service Plan (PACE)	08	20		1			H2223	001	0	2019	02108, 02128, 02148 - 02152, 02155, 02176, 02180		2		2			2						www.neighborhoodpace.org	www.neighborhoodpace.org										(617)568-6377		(617)568-6377		(617)568-6377		(617)568-6377										(800)720-3480		(800)720-3480		(800)720-3480		(800)720-3480																
H2223	002	0	1	20	08	H2223_002_0	1	1				05/21/2018	2019.01	05/21/2018 11:37:12 AM Eastern Daylight Time		05/21/2018 11:27:15 AM Eastern Daylight Time			05/21/2018 11:38:55 AM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Neighborhood PACE	www.ebnhc.org/elderservice.php	East Boston Elder Service Plan (PACE)	08	20		1			H2223	002	0	2019	02108, 02128, 02148 - 02152, 02155, 02176, 02180		2		2			2						www.neighborhoodpace.org	www.neighborhoodpace.org										(617)568-6377		(617)568-6377		(617)568-6377		(617)568-6377										(800)720-3480		(800)720-3480		(800)720-3480		(800)720-3480																
H2224	001	0	1	01	01	H2224_001_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 07:22:55 PM Eastern Daylight Time	08/06/2018 11:08:13 PM Eastern Daylight Time	08/06/2018 11:08:21 PM Eastern Daylight Time			08/06/2018 11:13:58 PM Eastern Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health (HMO SNP)	01	01		1			H2224	001	0	2019	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2	101860	2			1	3		2		1	www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2224	003	0	1	01	01	H2224_003_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 07:23:06 PM Eastern Daylight Time	08/06/2018 11:08:32 PM Eastern Daylight Time	08/06/2018 11:08:40 PM Eastern Daylight Time			08/06/2018 11:13:58 PM Eastern Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health NHC (HMO SNP)	01	01		1			H2224	003	0	2019	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2	74552	2			1	3		2		1	www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2225	001	0	1	01	01	H2225_001_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 01:41:48 PM Eastern Daylight Time	08/02/2018 01:39:46 PM Eastern Daylight Time	08/02/2018 01:39:46 PM Eastern Daylight Time			08/02/2018 01:44:24 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthcaresco.org	Senior Care Options Program (HMO SNP)	01	01		1			H2225	001	0	2019	BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR		2		2			1	3		1		1	http://www.commonwealthcarealliance.org/members/pharmacy-program	http://www.commonwealthcarealliance.org/getmedia/fbd4fa82-2aaf-469d-b4fb-1377acbe5c36/2018_SCO_Formu	www.commonwealthcarealliance.org	(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H2226	001	0	1	01	01	H2226_001_0	2	1	2	1		06/01/2018	2019.01	06/01/2018 02:21:53 PM Central Daylight Time	08/03/2018 11:39:09 AM Central Daylight Time	07/31/2018 06:12:44 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Senior Care Options (HMO SNP)	01	01		1			H2226	001	0	2019	Boston, Springfield and Worcester Metro Areas		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2228	001	0	1	04	01	H2228_001_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:46:48 PM Central Daylight Time	08/03/2018 10:08:14 AM Central Daylight Time	07/31/2018 06:13:08 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2228	001	0	2019	Boston, Springfield and Worcester Metro Areas		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	002	0	1	04	01	H2228_002_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:47:40 PM Central Daylight Time	08/03/2018 09:49:34 AM Central Daylight Time	07/31/2018 06:13:32 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2228	002	0	2019	State of Rhode Island		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	010	0	1	04	01	H2228_010_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:48:18 PM Central Daylight Time	08/03/2018 09:50:00 AM Central Daylight Time	07/31/2018 06:13:58 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2228	010	0	2019	Select Counties in Delaware, Maryland and Virginia		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	011	0	1	04	01	H2228_011_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:49:05 PM Central Daylight Time	08/03/2018 09:50:27 AM Central Daylight Time	07/31/2018 06:14:20 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H2228	011	0	2019	Select Counties in Maryland		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	013	0	1	04	01	H2228_013_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:49:44 PM Central Daylight Time	08/03/2018 09:50:53 AM Central Daylight Time	07/31/2018 06:14:54 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2228	013	0	2019	Select Counties in Georgia		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	016	0	1	04	01	H2228_016_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:51:18 PM Central Daylight Time	08/03/2018 09:51:20 AM Central Daylight Time	07/31/2018 06:15:18 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2228	016	0	2019	Select Counties in Oregon		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	017	0	1	04	01	H2228_017_0	2	1		1		05/25/2018	2019.01	05/25/2018 09:24:53 AM Central Daylight Time	08/03/2018 09:51:46 AM Central Daylight Time	07/31/2018 06:15:40 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 1 (PPO SNP)	01	04		1			H2228	017	0	2019	Select Counties in Oregon		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	018	0	1	04	01	H2228_018_0	2	1				05/31/2018	2019.01	05/31/2018 03:05:32 PM Central Daylight Time	08/03/2018 09:52:13 AM Central Daylight Time	07/31/2018 06:16:02 PM Central Daylight Time			08/06/2018 08:39:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	018	0	2019	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	019	0	1	04	01	H2228_019_0	4	1				07/12/2018	2019.01	07/12/2018 12:57:23 PM Central Daylight Time	08/03/2018 09:52:40 AM Central Daylight Time	07/31/2018 06:16:28 PM Central Daylight Time			08/06/2018 12:10:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	019	0	2019	Northern Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	020	0	1	04	01	H2228_020_0	4	1				08/02/2018	2019.01	08/02/2018 03:23:10 PM Central Daylight Time	08/03/2018 09:53:07 AM Central Daylight Time	07/31/2018 06:16:52 PM Central Daylight Time			08/06/2018 12:10:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (PPO)	01	04		1			H2228	020	0	2019	Fort Wayne area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	021	0	1	04	01	H2228_021_0	4	1				07/12/2018	2019.01	07/12/2018 01:01:16 PM Central Daylight Time	08/03/2018 09:53:33 AM Central Daylight Time	07/31/2018 06:17:14 PM Central Daylight Time			08/06/2018 12:10:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	021	0	2019	Indianapolis and Central Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	022	0	1	04	01	H2228_022_0	4	1				07/12/2018	2019.01	07/12/2018 01:10:49 PM Central Daylight Time	08/03/2018 09:54:00 AM Central Daylight Time	07/31/2018 06:17:38 PM Central Daylight Time			08/06/2018 12:10:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	022	0	2019	Evansville area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	023	0	1	04	01	H2228_023_0	4	1				08/02/2018	2019.01	08/02/2018 12:57:49 PM Central Daylight Time	08/03/2018 09:54:27 AM Central Daylight Time	07/31/2018 06:18:00 PM Central Daylight Time			08/06/2018 09:12:28 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	023	0	2019	El Paso and Southwest New Mexico		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	024	0	1	04	01	H2228_024_0	3	1				08/03/2018	2019.01	08/03/2018 08:45:01 AM Central Daylight Time	08/03/2018 09:54:54 AM Central Daylight Time	07/31/2018 06:18:24 PM Central Daylight Time			08/06/2018 08:39:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H2228	024	0	2019	Honolulu County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	025	0	1	04	01	H2228_025_0	2	1				07/12/2018	2019.01	07/12/2018 12:56:40 PM Central Daylight Time	06/01/2018 04:39:24 PM Central Daylight Time				07/13/2018 09:07:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Essential (PPO)	01	04		1			H2228	025	0	2019	Honolulu County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	029	0	1	04	01	H2228_029_0	3	1				07/12/2018	2019.01	07/12/2018 01:00:20 PM Central Daylight Time	08/03/2018 09:55:48 AM Central Daylight Time	07/31/2018 06:18:46 PM Central Daylight Time			08/06/2018 08:39:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	029	0	2019	Portland, Salem, and Eugene Metro Areas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	030	0	1	04	01	H2228_030_0	3	1				08/06/2018	2019.01	08/06/2018 10:11:03 AM Central Daylight Time	08/03/2018 09:56:14 AM Central Daylight Time	07/31/2018 06:19:14 PM Central Daylight Time			08/06/2018 10:14:08 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H2228	030	0	2019	St. Louis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	031	0	1	04	01	H2228_031_0	3	1				07/12/2018	2019.01	07/12/2018 12:37:51 PM Central Daylight Time	08/03/2018 09:56:41 AM Central Daylight Time	07/31/2018 06:19:38 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	031	0	2019	Ada and Canyon counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	032	0	1	04	01	H2228_032_0	3	1				07/12/2018	2019.01	07/12/2018 12:34:35 PM Central Daylight Time	08/03/2018 09:57:07 AM Central Daylight Time	07/31/2018 06:20:02 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2228	032	0	2019	Ada and Canyon counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	035	0	1	04	01	H2228_035_0	3	1				07/12/2018	2019.01	07/12/2018 03:11:09 PM Central Daylight Time	08/03/2018 09:57:34 AM Central Daylight Time	07/31/2018 06:20:24 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H2228	035	0	2019	Philadelphia Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	036	0	1	04	01	H2228_036_0	3	1				07/12/2018	2019.01	07/12/2018 03:11:20 PM Central Daylight Time	08/03/2018 09:58:00 AM Central Daylight Time	07/31/2018 06:20:48 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2228	036	0	2019	Philadelphia Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	037	0	1	04	01	H2228_037_0	3	1				07/12/2018	2019.01	07/12/2018 01:04:53 PM Central Daylight Time	08/03/2018 09:58:27 AM Central Daylight Time	07/31/2018 06:21:10 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	037	0	2019	Bucks, Chester and Philadelphia counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)393-0993		(800)393-0993		(800)555-5757		(800)555-5757		(800)393-0993		(800)393-0993		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	039	0	1	04	01	H2228_039_0	3	1		1		05/24/2018	2019.01	05/24/2018 01:27:27 PM Central Daylight Time	08/03/2018 09:58:53 AM Central Daylight Time	07/31/2018 06:21:34 PM Central Daylight Time			08/06/2018 10:37:45 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H2228	039	0	2019	Select Counties in Rhode Island		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	041	0	1	04	01	H2228_041_0	2	1	2	1		05/31/2018	2019.01	05/31/2018 05:39:28 PM Central Daylight Time	08/03/2018 09:59:20 AM Central Daylight Time	07/31/2018 06:21:58 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	041	0	2019	El Paso County		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	042	0	1	04	01	H2228_042_0	2	1	2	1		06/01/2018	2019.01	06/01/2018 10:22:06 AM Central Daylight Time	08/03/2018 09:59:46 AM Central Daylight Time	07/31/2018 06:22:26 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	042	0	2019	Dona Ana, Grant, Hidalgo, Luna and Sierra counties		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	043	0	1	04	01	H2228_043_0	2	1	2	1		06/01/2018	2019.01	06/01/2018 03:21:57 PM Central Daylight Time	08/03/2018 10:00:14 AM Central Daylight Time	07/31/2018 06:22:52 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	043	0	2019	Honolulu County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	044	0	1	04	01	H2228_044_0	2	1	2	1		06/01/2018	2019.01	06/01/2018 10:22:15 AM Central Daylight Time	08/03/2018 10:00:41 AM Central Daylight Time	07/31/2018 06:23:16 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	044	0	2019	Atlanta and Macon Metro Areas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	045	0	1	04	01	H2228_045_0	2	1	2	1		06/01/2018	2019.01	06/01/2018 03:22:30 PM Central Daylight Time	08/03/2018 10:01:08 AM Central Daylight Time	07/31/2018 06:23:44 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	045	0	2019	Washington, DC		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	046	0	1	04	01	H2228_046_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:09:02 PM Central Daylight Time	08/03/2018 10:01:33 AM Central Daylight Time	07/31/2018 06:24:10 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	046	0	2019	Bernalillo, Sandoval, Santa Fe, Valencia Counties		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	047	0	1	04	01	H2228_047_0	5	1				07/12/2018	2019.01	07/12/2018 11:46:37 AM Central Daylight Time	08/03/2018 10:02:00 AM Central Daylight Time	07/31/2018 06:24:32 PM Central Daylight Time			08/06/2018 09:12:28 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	047	0	2019	Bernalillo, Sandoval, and Valencia counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	048	0	1	04	01	H2228_048_0	3	1				08/06/2018	2019.01	08/06/2018 10:11:12 AM Central Daylight Time	08/03/2018 10:02:26 AM Central Daylight Time	07/31/2018 06:24:54 PM Central Daylight Time			08/06/2018 10:14:08 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2228	048	0	2019	St. Louis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	049	0	1	04	01	H2228_049_0	4	1				07/12/2018	2019.01	07/12/2018 03:38:09 PM Central Daylight Time	08/03/2018 10:02:53 AM Central Daylight Time	07/31/2018 06:25:18 PM Central Daylight Time			08/06/2018 09:12:28 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	049	0	2019	Santa Fe Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	064	0	1	04	01	H2228_064_0	5	1				07/12/2018	2019.01	07/12/2018 01:29:30 PM Central Daylight Time	08/03/2018 10:03:19 AM Central Daylight Time	07/31/2018 06:25:46 PM Central Daylight Time			08/06/2018 12:10:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	064	0	2019	Northwest Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	065	0	1	04	01	H2228_065_0	5	1				07/12/2018	2019.01	07/12/2018 01:29:55 PM Central Daylight Time	08/03/2018 10:03:47 AM Central Daylight Time	07/31/2018 06:26:08 PM Central Daylight Time			08/06/2018 12:10:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	065	0	2019	Southeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	066	0	1	04	01	H2228_066_0	5	1				07/12/2018	2019.01	07/12/2018 01:30:14 PM Central Daylight Time	08/03/2018 10:04:13 AM Central Daylight Time	07/31/2018 06:26:32 PM Central Daylight Time			08/06/2018 12:10:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	066	0	2019	West Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	067	0	1	04	01	H2228_067_0	4	1				07/12/2018	2019.01	07/12/2018 01:00:52 PM Central Daylight Time	08/03/2018 10:04:40 AM Central Daylight Time	07/31/2018 06:26:54 PM Central Daylight Time			08/06/2018 08:39:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2228	067	0	2019	Honolulu county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	068	0	1	04	01	H2228_068_0	4	1				07/12/2018	2019.01	07/12/2018 01:01:17 PM Central Daylight Time	08/03/2018 10:05:06 AM Central Daylight Time	07/31/2018 06:27:16 PM Central Daylight Time			08/06/2018 08:39:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	068	0	2019	Kauai and Maui Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	071	0	1	04	01	H2228_071_0	4	1				08/02/2018	2019.01	08/02/2018 02:27:37 PM Central Daylight Time	08/03/2018 10:05:33 AM Central Daylight Time	07/31/2018 06:27:40 PM Central Daylight Time			08/06/2018 09:36:47 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	071	0	2019	Kansas City Metro Area		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	805	0	1	04	01	H2228_805_0	1	1				05/30/2018	2019.01	05/30/2018 03:19:42 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	805	0	2019	National Service Area		1	10572	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	807	0	1	04	01	H2228_807_0	1	1				05/30/2018	2019.01	05/30/2018 03:21:43 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	807	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2228	808	0	1	04	01	H2228_808_0	1	1				05/30/2018	2019.01	05/30/2018 03:23:13 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	808	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	809	0	2	04	01	H2228_809_0	1	1				05/30/2018	2019.01	05/30/2018 03:25:10 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	809	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	810	0	2	04	01	H2228_810_0	1	1				05/30/2018	2019.01	05/30/2018 03:27:02 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	810	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2228	811	0	2	04	01	H2228_811_0	1	1				05/30/2018	2019.01	05/30/2018 03:28:34 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	811	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	812	0	1	04	01	H2228_812_0	1	1				05/30/2018	2019.01	05/30/2018 03:30:05 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	812	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	813	0	1	04	01	H2228_813_0	1	1				05/30/2018	2019.01	05/30/2018 03:31:35 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	813	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	814	0	1	04	01	H2228_814_0	1	1				05/30/2018	2019.01	05/30/2018 03:32:59 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	814	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	815	0	1	04	01	H2228_815_0	1	1				05/30/2018	2019.01	05/30/2018 03:34:46 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	815	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2228	816	0	1	04	01	H2228_816_0	1	1				05/30/2018	2019.01	05/30/2018 03:36:14 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	816	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	817	0	2	04	01	H2228_817_0	1	1				05/30/2018	2019.01	05/30/2018 03:38:12 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	817	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	818	0	2	04	01	H2228_818_0	1	1				05/30/2018	2019.01	05/30/2018 03:40:47 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	818	0	2019	Nationwide		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2228	819	0	2	04	01	H2228_819_0	1	1				05/30/2018	2019.01	05/30/2018 03:45:00 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	819	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	820	0	1	04	01	H2228_820_0	1	1				05/30/2018	2019.01	05/30/2018 03:46:59 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	820	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	821	0	1	04	01	H2228_821_0	1	1				05/30/2018	2019.01	05/30/2018 03:48:25 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	821	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	822	0	1	04	01	H2228_822_0	1	1				05/30/2018	2019.01	05/30/2018 03:49:52 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	822	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2228	823	0	1	04	01	H2228_823_0	1	1				05/30/2018	2019.01	05/30/2018 03:51:38 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	823	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	824	0	1	04	01	H2228_824_0	1	1				05/30/2018	2019.01	05/30/2018 03:53:04 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	824	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	825	0	1	04	01	H2228_825_0	1	1				05/30/2018	2019.01	05/30/2018 03:54:22 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	825	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	826	0	1	04	01	H2228_826_0	1	1				05/30/2018	2019.01	05/30/2018 03:56:34 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	826	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	827	0	1	04	01	H2228_827_0	1	1				05/30/2018	2019.01	05/30/2018 04:12:36 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	827	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	828	0	1	04	01	H2228_828_0	1	1				05/30/2018	2019.01	05/30/2018 04:14:53 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	828	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	829	0	2	04	01	H2228_829_0	1	1				05/30/2018	2019.01	05/30/2018 04:16:53 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	829	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	830	0	1	04	01	H2228_830_0	1	1				05/30/2018	2019.01	05/30/2018 04:18:14 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	830	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2228	831	0	1	04	01	H2228_831_0	1	1				05/30/2018	2019.01	05/30/2018 04:19:36 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	831	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	832	0	1	04	01	H2228_832_0	1	1				05/30/2018	2019.01	05/30/2018 04:28:34 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	832	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	833	0	1	04	01	H2228_833_0	1	1				05/30/2018	2019.01	05/30/2018 04:30:36 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	833	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	834	0	1	04	01	H2228_834_0	1	1				05/30/2018	2019.01	05/30/2018 04:31:49 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	834	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2228	835	0	1	04	01	H2228_835_0	1	1				05/30/2018	2019.01	05/30/2018 04:33:21 PM Central Daylight Time					06/02/2018 03:08:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	835	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2230	002	0	1	04	01	H2230_002_0	5	1			1	07/09/2018	2019.01	07/09/2018 03:14:22 PM Eastern Daylight Time	08/03/2018 01:45:21 PM Eastern Daylight Time	08/02/2018 10:03:13 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue PlusRx (PPO)	01	04		1			H2230	002	0	2019	Massachusetts except Berkshire Dukes and Nantucket		2	80883	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	017	0	1	04	01	H2230_017_0	4	1			1	07/09/2018	2019.01	07/09/2018 02:13:06 PM Eastern Daylight Time	08/03/2018 01:46:17 PM Eastern Daylight Time	08/02/2018 10:03:37 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue SaverRx (PPO)	01	04		1			H2230	017	0	2019	Massachusetts except Berkshire Dukes and Nantucket		2	117991	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	018	1	1	04	01	H2230_018_1	5	1			1	08/03/2018	2019.01	08/03/2018 02:42:14 PM Eastern Daylight Time	08/03/2018 01:47:13 PM Eastern Daylight Time	08/02/2018 10:04:01 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue ValueRx (PPO)	01	04		1			H2230	018	1	2019	Massachusetts except Berkshire Dukes and Nantucket	Massachusetts except BER, DUK, NAN, WOR	2	239045	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	018	2	1	04	01	H2230_018_2	5	1			1	08/03/2018	2019.01	08/03/2018 02:42:19 PM Eastern Daylight Time	08/03/2018 01:48:11 PM Eastern Daylight Time	08/02/2018 10:04:25 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue ValueRx (PPO)	01	04		1			H2230	018	2	2019	Massachusetts except Berkshire Dukes and Nantucket	Worcester, MA	2	88694	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	801	0	1	04	01	H2230_801_0	3	1				05/31/2018	2019.01	05/31/2018 02:02:41 PM Eastern Daylight Time					06/04/2018 11:40:43 AM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue (PPO)	01	04		1			H2230	801	0	2019	National Network		1	780	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7d;8a;8b1;9a1;9b;10a;11a;15;	2		1									
H2230	809	0	1	04	01	H2230_809_0	3	1				05/31/2018	2019.01	05/31/2018 02:02:45 PM Eastern Daylight Time					06/04/2018 11:40:43 AM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue (PPO)	01	04		1			H2230	809	0	2019	National Network		1	50	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7d;8a;8b1;9a1;9b;10a;11a;15;	2		1									
H2235	001	0	1	01	01	H2235_001_0	10	1				08/02/2018	2019.01	08/02/2018 01:57:15 PM Central Daylight Time	08/02/2018 12:36:42 PM Central Daylight Time	08/01/2018 02:09:42 PM Central Daylight Time			08/03/2018 11:19:53 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Select Health Plans	www.BayCarePlus.org	BayCarePlus Complete (HMO)	01	01		1			H2235	001	0	2019	Hillsborough, Pasco, Pinellas and Polk counties		2	36596	2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2235	002	0	1	01	01	H2235_002_0	8	1				08/01/2018	2019.01	08/01/2018 03:31:56 PM Central Daylight Time	08/01/2018 02:17:41 PM Central Daylight Time	08/01/2018 02:21:32 PM Central Daylight Time			08/03/2018 11:19:53 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Select Health Plans	www.BayCarePlus.org	BayCarePlus Rewards (HMO)	01	01		1			H2235	002	0	2019	Hillborough, Pasco, Pinellas and Polk counties		2	19331	2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2235	801	0	1	01	01	H2235_801_0	3	1				05/29/2018	2019.01	05/29/2018 08:45:03 AM Central Daylight Time					06/01/2018 10:08:23 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Select Health Plans	www.BayCarePlus.org	BayCarePlus EGWP MAPD calendar (HMO)	01	01		1			H2235	801	0	2019	Hillsborough, Pasco, Pinellas and Polk counties		1	300	2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;	1					1				
H2235	802	0	1	01	01	H2235_802_0	3	1				05/24/2018	2019.01	05/24/2018 01:40:05 PM Central Daylight Time					06/01/2018 10:08:23 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Select Health Plans	www.BayCarePlus.org	BayCarePlus EGWP MAPD non calendar (HMO)	01	01		1			H2235	802	0	2019	Hillsborough, Pasco, Pinellas and Polk counties		1	300	2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;	1					1				
H2237	001	0	1	01	01	H2237_001_0	4	1	2	1		05/30/2018	2019.01	05/30/2018 11:17:08 AM Central Daylight Time	08/01/2018 01:15:25 PM Central Daylight Time	08/01/2018 01:24:23 PM Central Daylight Time			08/06/2018 03:11:36 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icarehealthplan.org	iCare Medicare Plan (HMO SNP)	01	01		1			H2237	001	0	2019	Eastern, South Central and Western Wisconsin		2	83384	2			1	3		2		2	www.icarehealthplan.org	www.icarehealthplan.org	www.icarehealthplan.org	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(855)689-7690		(414)223-4847		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2	2			
H2237	007	0	1	01	01	H2237_007_0	4	1	2	1		05/30/2018	2019.01	05/30/2018 11:17:44 AM Central Daylight Time	08/01/2018 01:17:42 PM Central Daylight Time	08/01/2018 01:25:50 PM Central Daylight Time			08/06/2018 03:11:36 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icarehealthplan.org	iCare Family Care Partnership (HMO SNP)	01	01		1			H2237	007	0	2019	Milwaukee, Racine, Kenosha, Dane and Sauk Counties		2	8587	2			1	3		1		2	www.icarehealthplan.org	www.icarehealthplan.org	www.icarehealthplan.org	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(855)689-7690		(414)223-4847		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2	2			
H2237	009	0	1	01	01	H2237_009_0	4	1	2	1		05/30/2018	2019.01	05/30/2018 11:18:05 AM Central Daylight Time	08/01/2018 01:20:17 PM Central Daylight Time	08/01/2018 01:26:45 PM Central Daylight Time			08/06/2018 03:11:36 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icarehealthplan.org/aurora	Aurora Complete Care (HMO SNP)	01	01		1			H2237	009	0	2019	Milwaukee, Waukesha and SE Wis. Counties		2	7736	2			1	3		2		2	www.icarehealthplan.org/aurora	www.icarehealthplan.org/aurora	www.icarehealthplan.org/aurora	(855)818-1129		(414)299-5549		(888)241-9637		(414)299-5549		(855)818-1129		(414)299-5549		(855)689-7690		(414)299-5549		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2	2			
H2237	010	0	1	01	01	H2237_010_0	4	1	2	1		05/26/2018	2019.01	05/26/2018 04:47:55 PM Central Daylight Time	08/01/2018 01:21:47 PM Central Daylight Time	08/01/2018 01:39:59 PM Central Daylight Time			08/06/2018 03:11:36 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icarehealthplan.org/lakeland	Lakeland Care +Health (HMO SNP)	01	01		1			H2237	010	0	2019	Northeast Wisconsin		2	4777	2			1	3		2		2	www.icarehealthplan.org/lakeland	www.icarehealthplan.org/lakeland	www.icarehealthplan.org/lakeland	(855)306-7918		(414)299-5517		(888)241-9637		(414)299-5517		(855)306-7918		(414)299-5517		(855)689-7690		(414)299-5517		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2	2			
H2241	007	1	1	01	01	H2241_007_1	8	1				08/07/2018	2019.01	08/07/2018 07:43:44 PM Pacific Daylight Time	08/07/2018 12:22:36 PM Pacific Daylight Time	08/07/2018 12:22:37 PM Pacific Daylight Time			08/07/2018 07:44:26 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.GoldenStateMHP.com	Golden State (HMO)	01	01		1			H2241	007	1	2019	LA*/OC*/RV*/STA/SLO Counties-*Partial	LA*/OC*/RV*/STA Counties-Partial*	2		2			2						www.goldenstatemhp.com	www.goldenstatemhp.com	www.GoldenStateMHP.com	(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		2					2					2	2			
H2241	007	2	1	01	01	H2241_007_2	7	1				08/07/2018	2019.01	08/07/2018 12:18:40 PM Pacific Daylight Time	08/07/2018 12:22:37 PM Pacific Daylight Time	08/07/2018 12:22:38 PM Pacific Daylight Time			08/07/2018 12:25:11 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.GoldenStateMHP.com	Golden State (HMO)	01	01		1			H2241	007	2	2019	LA*/OC*/RV*/STA/SLO Counties-*Partial	San Luis Obispo County	2		2			2						www.goldenstatemhp.com	www.goldenstatemhp.com	www.GoldenStateMHP.com	(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		2					2					2	2			
H2241	009	0	1	01	01	H2241_009_0	5	1				08/06/2018	2019.01	08/06/2018 04:30:26 PM Pacific Daylight Time	08/07/2018 12:22:38 PM Pacific Daylight Time	08/07/2018 12:22:39 PM Pacific Daylight Time			08/07/2018 12:25:11 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.GoldenStateMHP.com	Golden State (HMO)	01	01		1			H2241	009	0	2019	Contra Costa County		2		2			2						www.goldenstatemhp.com	www.goldenstatemhp.com	www.GoldenStateMHP.com	(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		2					2					2	2			
H2247	001	0	1	01	01	H2247_001_0	4	1	2	1		05/30/2018	2019.01	05/30/2018 05:50:00 PM Central Daylight Time	08/03/2018 09:56:09 AM Central Daylight Time	07/31/2018 06:28:04 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H2247	001	0	2019	Select Counties in MI		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-6885		(844)368-6885		(888)834-3721		(888)834-3721		(844)368-6885		(844)368-6885		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	001	1	1	01	01	H2256_001_1	7	1			1	08/03/2018	2019.01	08/03/2018 10:47:56 AM Eastern Daylight Time	08/03/2018 10:55:22 AM Eastern Daylight Time	08/02/2018 10:05:42 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	1	2019	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	001	2	1	01	01	H2256_001_2	7	1			1	06/01/2018	2019.01	06/01/2018 04:37:15 PM Eastern Daylight Time	08/03/2018 10:55:56 AM Eastern Daylight Time	08/02/2018 10:06:38 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	2	2019	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	001	6	1	01	01	H2256_001_6	7	1			1	06/01/2018	2019.01	06/01/2018 04:38:18 PM Eastern Daylight Time	08/03/2018 10:56:28 AM Eastern Daylight Time	08/02/2018 10:07:30 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	6	2019	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	015	1	1	01	01	H2256_015_1	7	1			1	06/01/2018	2019.01	06/01/2018 02:21:30 PM Eastern Daylight Time	08/03/2018 10:57:02 AM Eastern Daylight Time	08/02/2018 10:08:18 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	1	2019	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	015	2	1	01	01	H2256_015_2	7	1			1	06/01/2018	2019.01	06/01/2018 02:25:53 PM Eastern Daylight Time	08/03/2018 10:57:36 AM Eastern Daylight Time	08/02/2018 10:09:12 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	2	2019	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	015	6	1	01	01	H2256_015_6	7	1			1	06/01/2018	2019.01	06/01/2018 02:27:01 PM Eastern Daylight Time	08/03/2018 10:58:10 AM Eastern Daylight Time	08/02/2018 10:09:56 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	6	2019	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	016	1	1	01	01	H2256_016_1	6	1			1	06/01/2018	2019.01	06/01/2018 02:27:30 PM Eastern Daylight Time	07/19/2018 01:37:00 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	1	2019	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	016	2	1	01	01	H2256_016_2	6	1			1	06/01/2018	2019.01	06/01/2018 02:31:00 PM Eastern Daylight Time	07/19/2018 01:37:34 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	2	2019	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	018	1	1	01	01	H2256_018_1	7	1			1	06/01/2018	2019.01	06/01/2018 02:31:40 PM Eastern Daylight Time	08/03/2018 10:58:42 AM Eastern Daylight Time	08/02/2018 10:10:40 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	1	2019	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	018	7	1	01	01	H2256_018_7	7	1			1	06/01/2018	2019.01	06/01/2018 02:33:36 PM Eastern Daylight Time	08/03/2018 10:59:14 AM Eastern Daylight Time	08/02/2018 10:11:32 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	7	2019	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	018	8	1	01	01	H2256_018_8	7	1			1	06/01/2018	2019.01	06/01/2018 02:33:53 PM Eastern Daylight Time	08/03/2018 10:59:48 AM Eastern Daylight Time	08/02/2018 10:13:28 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	8	2019	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	019	1	1	01	01	H2256_019_1	6	1			1	06/01/2018	2019.01	06/01/2018 03:13:40 PM Eastern Daylight Time	07/19/2018 01:39:50 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	1	2019	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	019	7	1	01	01	H2256_019_7	6	1			1	06/01/2018	2019.01	06/01/2018 03:14:31 PM Eastern Daylight Time	07/19/2018 01:40:24 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	7	2019	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	026	1	1	01	01	H2256_026_1	7	1			1	06/01/2018	2019.01	06/01/2018 01:52:06 PM Eastern Daylight Time	08/03/2018 11:00:20 AM Eastern Daylight Time	08/02/2018 10:14:12 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	1	2019	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	026	2	1	01	01	H2256_026_2	7	1			1	06/01/2018	2019.01	06/01/2018 01:53:45 PM Eastern Daylight Time	08/03/2018 11:00:52 AM Eastern Daylight Time	08/02/2018 10:14:56 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	2	2019	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	026	3	1	01	01	H2256_026_3	7	1			1	06/01/2018	2019.01	06/01/2018 01:54:23 PM Eastern Daylight Time	08/03/2018 11:01:24 AM Eastern Daylight Time	08/02/2018 10:15:40 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	3	2019	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	028	0	1	01	01	H2256_028_0	7	1			1	06/01/2018	2019.01	06/01/2018 01:24:17 PM Eastern Daylight Time	08/03/2018 11:01:58 AM Eastern Daylight Time	08/02/2018 10:16:26 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Saver Rx (HMO)	01	01		1			H2256	028	0	2019	Most of Massachusetts		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	029	0	1	01	01	H2256_029_0	8	1	2	1	2	08/06/2018	2019.01	08/06/2018 12:32:56 PM Eastern Daylight Time	08/06/2018 10:22:18 AM Eastern Daylight Time	08/06/2018 10:20:56 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/sco	Tufts Health Plan Senior Care Options (HMO SNP)	01	01		1			H2256	029	0	2019	Most of Massachusetts		2		2			1	3		1		1	tufts-sco.prismisp.com	tuftsmedicarepreferred.org/drug-coverage	tufts-sco.prismisp.com	(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	033	0	1	01	01	H2256_033_0	7	1			1	06/01/2018	2019.01	06/01/2018 02:36:10 PM Eastern Daylight Time	08/03/2018 11:02:30 AM Eastern Daylight Time	08/02/2018 10:17:10 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	033	0	2019	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	034	0	1	01	01	H2256_034_0	7	1			1	06/01/2018	2019.01	06/01/2018 02:36:39 PM Eastern Daylight Time	08/03/2018 11:03:02 AM Eastern Daylight Time	08/02/2018 10:17:54 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	034	0	2019	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	036	0	1	01	01	H2256_036_0	7	1			1	06/01/2018	2019.01	06/01/2018 02:36:57 PM Eastern Daylight Time	08/03/2018 11:03:34 AM Eastern Daylight Time	08/02/2018 10:18:36 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	036	0	2019	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	039	0	1	01	01	H2256_039_0	6	1			1	06/01/2018	2019.01	06/01/2018 02:37:27 PM Eastern Daylight Time	07/19/2018 01:44:44 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	039	0	2019	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	040	0	1	01	01	H2256_040_0	6	1			1	06/01/2018	2019.01	06/01/2018 03:50:00 PM Eastern Daylight Time	07/19/2018 01:45:16 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	040	0	2019	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	041	0	1	01	01	H2256_041_0	6	1			1	06/01/2018	2019.01	06/01/2018 02:38:51 PM Eastern Daylight Time	07/19/2018 01:45:48 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	01	01		1			H2256	041	0	2019	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	042	0	1	01	01	H2256_042_0	6	1			1	06/01/2018	2019.01	06/01/2018 02:39:09 PM Eastern Daylight Time	07/19/2018 01:46:20 PM Eastern Daylight Time				07/20/2018 10:01:26 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	01	01		1			H2256	042	0	2019	Essex and Suffolk Counties		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	801	0	1	01	01	H2256_801_0	5	1				06/01/2018	2019.01	06/01/2018 03:04:35 PM Eastern Daylight Time					06/04/2018 03:16:04 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO Rx (HMO)	01	01		1			H2256	801	0	2019	Most of Massachusetts		1	95976	2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	802	0	1	01	01	H2256_802_0	5	1				06/01/2018	2019.01	06/01/2018 03:05:58 PM Eastern Daylight Time					06/04/2018 03:16:04 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO (HMO)	01	01		1			H2256	802	0	2019	Most of Massachusetts		1	63281	2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	803	0	1	01	01	H2256_803_0	5	1				06/01/2018	2019.01	06/01/2018 03:06:48 PM Eastern Daylight Time					06/04/2018 03:16:04 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO Rx (HMO)	01	01		1			H2256	803	0	2019	Most of Massachusetts		1	12	2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	808	0	1	01	01	H2256_808_0	5	1				06/01/2018	2019.01	06/01/2018 03:07:07 PM Eastern Daylight Time					06/04/2018 03:16:04 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO (HMO)	01	01		1			H2256	808	0	2019	Most of Massachusetts		1	12	2			2						tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2261	005	0	1	01	01	H2261_005_0	5	1			1	08/03/2018	2019.01	08/03/2018 02:41:37 PM Eastern Daylight Time	08/03/2018 01:49:12 PM Eastern Daylight Time	08/02/2018 10:04:49 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue PlusRx (HMO)	01	01		1			H2261	005	0	2019	Massachusetts except Berkshire Dukes and Nantucket		2	33306	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	022	1	1	01	01	H2261_022_1	5	1			1	08/03/2018	2019.01	08/03/2018 02:41:42 PM Eastern Daylight Time	08/03/2018 01:50:11 PM Eastern Daylight Time	08/02/2018 10:05:13 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue ValueRx (HMO)	01	01		1			H2261	022	1	2019	Massachusetts except Berkshire, Dukes, Nantucket	Massachusetts except BER, DUK, NAN, WOR	2	49725	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	022	2	1	01	01	H2261_022_2	5	1			1	08/03/2018	2019.01	08/03/2018 02:41:46 PM Eastern Daylight Time	08/03/2018 01:51:07 PM Eastern Daylight Time	08/02/2018 10:05:38 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue ValueRx (HMO)	01	01		1			H2261	022	2	2019	Massachusetts except Berkshire, Dukes, Nantucket	Worcester county	2	13175	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	023	1	1	02	01	H2261_023_1	6	1			1	08/03/2018	2019.01	08/03/2018 02:41:50 PM Eastern Daylight Time	08/03/2018 01:52:04 PM Eastern Daylight Time	08/02/2018 10:06:02 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue FlexRx (HMO-POS)	01	02		1			H2261	023	1	2019	Massachusetts except Berkshire Dukes and Nantucket	Massachusetts except BER, DUK, NAN, WOR	2	28030	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	023	2	1	02	01	H2261_023_2	6	1			1	08/03/2018	2019.01	08/03/2018 02:41:55 PM Eastern Daylight Time	08/03/2018 01:53:03 PM Eastern Daylight Time	08/02/2018 10:06:25 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue FlexRx (HMO-POS)	01	02		1			H2261	023	2	2019	Massachusetts except Berkshire Dukes and Nantucket	Worcester, MA	2	8775	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	024	0	1	01	01	H2261_024_0	5	1			1	08/03/2018	2019.01	08/03/2018 02:42:00 PM Eastern Daylight Time	08/03/2018 01:54:03 PM Eastern Daylight Time	08/02/2018 10:06:49 AM Eastern Daylight Time			08/03/2018 02:45:10 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue SaverRx (HMO)	01	01		1			H2261	024	0	2019	Massachusetts except Berkshire Dukes and Nantucket		2	4612	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	801	0	1	01	01	H2261_801_0	3	1				05/31/2018	2019.01	05/31/2018 02:03:15 PM Eastern Daylight Time					06/04/2018 11:40:43 AM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	01	01		1			H2261	801	0	2019	Massachusetts except Berkshire Dukes and Nantucket		1	18060	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;9a1;9b;10a;11a;12;15;	1	7d;7f;7i;14e3;	1					1				
H2261	809	0	1	01	01	H2261_809_0	3	1				05/31/2018	2019.01	05/31/2018 02:03:19 PM Eastern Daylight Time					06/04/2018 11:40:43 AM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	01	01		1			H2261	809	0	2019	Massachusetts except Berkshire Dukes and Nantucket		1	120	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;9a1;9b;10a;11a;12;15;	1	7d;7f;7i;14e3;	1					2				
H2288	001	0	1	01	01	H2288_001_0	9	1				06/04/2018	2019.01	06/04/2018 05:00:48 PM Central Daylight Time	08/02/2018 01:24:26 PM Central Daylight Time	08/02/2018 11:06:50 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage (HMO)	01	01		1			H2288	001	0	2019	Kings, New York, and Queens Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	002	0	1	01	01	H2288_002_0	9	1				06/04/2018	2019.01	06/04/2018 05:01:19 PM Central Daylight Time	08/02/2018 01:25:34 PM Central Daylight Time	08/02/2018 11:07:30 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Plus (HMO)	01	01		1			H2288	002	0	2019	Kings, New York, and Queens Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	003	0	1	01	01	H2288_003_0	11	1	2	1		07/06/2018	2019.01	07/06/2018 12:44:43 PM Central Daylight Time	08/02/2018 01:26:48 PM Central Daylight Time	08/02/2018 11:08:10 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Special Care (HMO SNP)	01	01		1			H2288	003	0	2019	New York County		2		2			1	3		1		1	https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4030		(844)202-4030		(844)713-0098		(844)713-0098		(844)202-4030		(844)202-4030		(844)713-0098		(844)713-0098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	005	0	1	01	01	H2288_005_0	9	1				06/04/2018	2019.01	06/04/2018 05:01:54 PM Central Daylight Time	08/02/2018 01:27:52 PM Central Daylight Time	08/02/2018 11:08:50 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Assist (HMO)	01	01		1			H2288	005	0	2019	Kings, New York, and Queens Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2292	001	0	1	04	01	H2292_001_0	5	1		1		08/02/2018	2019.01	08/02/2018 02:52:29 PM Central Daylight Time	08/03/2018 12:08:00 PM Central Daylight Time	07/31/2018 06:28:30 PM Central Daylight Time			08/06/2018 10:43:58 AM Central Daylight Time	OXFORD HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2292	001	0	2019	Upstate New York		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2292	002	0	1	04	01	H2292_002_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:53:04 PM Central Daylight Time	08/03/2018 12:08:28 PM Central Daylight Time	07/31/2018 06:28:54 PM Central Daylight Time			08/06/2018 10:43:58 AM Central Daylight Time	OXFORD HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2292	002	0	2019	New York City Metro Area		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2318	001	0	1	20	08	H2318_001_0	1	1				06/04/2018	2019.01	06/04/2018 09:06:50 AM Eastern Daylight Time		06/04/2018 09:15:14 AM Eastern Daylight Time			06/04/2018 09:16:16 AM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	001	0	2019	Michigan, Macomb, Oakland, Wayne Counties		2		2			2						www.henryford.com	Milwaukee.PACE@milliman.com										(855)445-4554		(855)445-4554		(855)445-4554		(855)445-4554										(711)-		(711)-		(711)-		(711)-																
H2318	002	0	1	20	08	H2318_002_0	1	1				06/04/2018	2019.01	06/04/2018 09:07:13 AM Eastern Daylight Time		06/04/2018 09:15:07 AM Eastern Daylight Time			06/04/2018 09:16:16 AM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	002	0	2019	Michigan, Macomb, Oakland, Wayne Counties		2		2			2						www.henryford.com	Milwaukee.PACE@milliman.com										(855)445-4554		(855)445-4554		(855)445-4554		(855)445-4554										(711)-		(711)-		(711)-		(711)-																
H2320	007	0	1	02	01	H2320_007_0	14	1				07/17/2018	2019.01	07/17/2018 04:08:17 PM Eastern Daylight Time	08/02/2018 03:25:14 PM Eastern Daylight Time	08/01/2018 10:11:24 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	007	0	2019	Region 2		2	33287	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	008	0	1	02	01	H2320_008_0	14	1				07/17/2018	2019.01	07/17/2018 01:24:24 PM Eastern Daylight Time	08/02/2018 03:26:08 PM Eastern Daylight Time	08/01/2018 10:11:48 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	008	0	2019	Region 3		2	15579	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	011	0	1	02	01	H2320_011_0	14	1				07/17/2018	2019.01	07/17/2018 01:24:45 PM Eastern Daylight Time	08/02/2018 03:27:06 PM Eastern Daylight Time	08/01/2018 10:12:12 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	011	0	2019	Region 2		2	116971	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	012	0	1	02	01	H2320_012_0	14	1				07/17/2018	2019.01	07/17/2018 01:25:04 PM Eastern Daylight Time	08/02/2018 03:28:04 PM Eastern Daylight Time	08/01/2018 10:12:36 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	012	0	2019	Region 3		2	30936	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	013	0	1	02	01	H2320_013_0	14	1				07/17/2018	2019.01	07/17/2018 01:25:21 PM Eastern Daylight Time	08/02/2018 03:28:58 PM Eastern Daylight Time	08/01/2018 10:13:00 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	013	0	2019	Region 1		2	137940	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	015	0	1	02	01	H2320_015_0	14	1				07/17/2018	2019.01	07/17/2018 01:25:42 PM Eastern Daylight Time	08/02/2018 03:29:44 PM Eastern Daylight Time	08/01/2018 10:13:24 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	015	0	2019	Region 1		2	532792	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	016	0	1	02	01	H2320_016_0	14	1				07/17/2018	2019.01	07/17/2018 01:26:04 PM Eastern Daylight Time	08/02/2018 03:30:34 PM Eastern Daylight Time	08/01/2018 10:13:48 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	016	0	2019	Region 4		2	6154	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	018	0	1	02	01	H2320_018_0	14	1				07/17/2018	2019.01	07/17/2018 01:26:27 PM Eastern Daylight Time	08/02/2018 03:31:24 PM Eastern Daylight Time	08/01/2018 10:14:12 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	018	0	2019	Region 4		2	24157	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	019	0	1	02	01	H2320_019_0	14	1				07/17/2018	2019.01	07/17/2018 01:26:47 PM Eastern Daylight Time	08/02/2018 03:32:12 PM Eastern Daylight Time	08/01/2018 10:14:38 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	019	0	2019	Region 5		2	8700	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	021	0	1	02	01	H2320_021_0	14	1				07/17/2018	2019.01	07/17/2018 01:27:12 PM Eastern Daylight Time	08/02/2018 03:33:02 PM Eastern Daylight Time	08/01/2018 10:15:02 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	021	0	2019	Region 5		2	36905	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	1	1	02	01	H2320_022_1	14	1				07/17/2018	2019.01	07/17/2018 01:27:28 PM Eastern Daylight Time	08/02/2018 03:33:50 PM Eastern Daylight Time	08/01/2018 10:15:26 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	1	2019	68 lower peninsula Michigan counties	Region 1	2	21852	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	2	1	02	01	H2320_022_2	14	1				07/17/2018	2019.01	07/17/2018 01:27:45 PM Eastern Daylight Time	08/02/2018 03:34:48 PM Eastern Daylight Time	08/01/2018 10:15:50 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	2	2019	68 lower peninsula Michigan counties	Region 2	2	49696	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	3	1	02	01	H2320_022_3	14	1				07/17/2018	2019.01	07/17/2018 01:28:04 PM Eastern Daylight Time	08/02/2018 03:35:46 PM Eastern Daylight Time	08/01/2018 10:16:14 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	3	2019	68 lower peninsula Michigan counties	Region 3	2	51757	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	4	1	02	01	H2320_022_4	14	1				07/17/2018	2019.01	07/17/2018 01:28:22 PM Eastern Daylight Time	08/02/2018 03:36:42 PM Eastern Daylight Time	08/01/2018 10:16:38 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	4	2019	68 lower peninsula Michigan counties	Region 4	2	34907	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	5	1	02	01	H2320_022_5	14	1				07/17/2018	2019.01	07/17/2018 01:28:39 PM Eastern Daylight Time	08/02/2018 03:37:38 PM Eastern Daylight Time	08/01/2018 10:17:02 AM Eastern Daylight Time			08/07/2018 07:18:17 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	5	2019	68 lower peninsula Michigan counties	Region 5	2	62292	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	802	0	1	02	01	H2320_802_0	9	1				07/16/2018	2019.01	07/16/2018 11:05:18 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Non-Calendar Year (HMO-POS)	01	02		1			H2320	802	0	2019	National		1	6344	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	803	0	1	02	01	H2320_803_0	9	1				07/16/2018	2019.01	07/16/2018 11:05:19 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Calendar Year (HMO-POS)	01	02		1			H2320	803	0	2019	National		1	236346	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	804	0	1	01	01	H2320_804_0	9	1				07/16/2018	2019.01	07/16/2018 11:11:44 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO w PD Non-Cal Year (HMO)	01	01		1			H2320	804	0	2019	State of Michigan		1	3645	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	805	0	1	01	01	H2320_805_0	9	1				07/16/2018	2019.01	07/16/2018 11:11:53 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO w PD Cal Year (HMO)	01	01		1			H2320	805	0	2019	State of Michigan		1	2951	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	810	0	1	01	01	H2320_810_0	9	1				07/16/2018	2019.01	07/16/2018 11:12:24 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO Cal Year (HMO) (HMO)	01	01		1			H2320	810	0	2019	State of Michigan		1	4	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	811	0	1	01	01	H2320_811_0	9	1				07/16/2018	2019.01	07/16/2018 11:12:36 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO Non-Cal Year (HMO) (HMO)	01	01		1			H2320	811	0	2019	State of Michigan		1	4	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	812	0	1	02	01	H2320_812_0	9	1				07/16/2018	2019.01	07/16/2018 11:12:53 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare HMO-POS No RX EGWP Calendar (HMO-POS)	01	02		1			H2320	812	0	2019	National		1	4	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	813	0	1	02	01	H2320_813_0	9	1				07/16/2018	2019.01	07/16/2018 11:13:03 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare HMO-POS No RX EGWP Non-Calendar (HMO-POS)	01	02		1			H2320	813	0	2019	National		1	4	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2322	004	0	1	04	01	H2322_004_0	6	1				07/31/2018	2019.01	07/31/2018 01:15:58 PM Eastern Daylight Time	08/07/2018 01:29:33 PM Eastern Daylight Time	08/07/2018 01:30:39 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 4 (PPO)	01	04		1			H2322	004	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	008	0	1	04	01	H2322_008_0	6	1				07/27/2018	2019.01	07/27/2018 12:11:50 PM Eastern Daylight Time	08/07/2018 01:29:34 PM Eastern Daylight Time	08/07/2018 01:30:39 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 3 (PPO)	01	04		1			H2322	008	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	011	0	1	04	01	H2322_011_0	6	1				07/17/2018	2019.01	07/17/2018 04:54:30 PM Eastern Daylight Time	08/07/2018 01:29:35 PM Eastern Daylight Time	08/07/2018 01:30:40 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 1 (PPO)	01	04		1			H2322	011	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	012	0	1	04	01	H2322_012_0	6	1				07/17/2018	2019.01	07/17/2018 04:54:55 PM Eastern Daylight Time	08/07/2018 01:29:37 PM Eastern Daylight Time	08/07/2018 01:30:40 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 2 (PPO)	01	04		1			H2322	012	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	801	0	1	04	01	H2322_801_0	3	1				06/01/2018	2019.01	06/01/2018 02:33:39 PM Eastern Daylight Time					06/04/2018 12:14:31 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Group (PPO)	01	04		1			H2322	801	0	2019	United States EG Area		1	2008	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H2322	803	0	1	04	01	H2322_803_0	3	1				06/01/2018	2019.01	06/01/2018 02:37:01 PM Eastern Daylight Time					06/04/2018 12:14:31 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Group (PPO)	01	04		1			H2322	803	0	2019	United States EG Area		1	704	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H2334	001	0	1	04	01	H2334_001_0	6	1		1		07/16/2018	2019.01	07/16/2018 09:18:48 AM Eastern Daylight Time	08/03/2018 09:22:40 AM Eastern Daylight Time	08/03/2018 10:07:07 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (SC)	Eon Health	www.eonhealthplan.com	EON GOLD (PPO SNP)	01	04		1			H2334	001	0	2019	Select South Carolina Counties		2		2			1	4			00000000000000000010		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2334	003	0	1	04	01	H2334_003_0	7	1				08/07/2018	2019.01	08/07/2018 03:00:04 PM Eastern Daylight Time	08/03/2018 09:21:45 AM Eastern Daylight Time	08/03/2018 10:06:11 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (SC)	Eon Health	www.eonhealthplan.com	EON CHOICE (PPO)	01	04		1			H2334	003	0	2019	Select South Carolina Counties		2		2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2354	015	0	1	01	01	H2354_015_0	6	1				07/17/2018	2019.01	07/17/2018 04:49:06 PM Eastern Daylight Time	08/07/2018 01:29:39 PM Eastern Daylight Time	08/07/2018 01:30:34 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus (HMO)	01	01		1			H2354	015	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	018	0	1	01	01	H2354_018_0	7	1				07/26/2018	2019.01	07/26/2018 12:42:37 PM Eastern Daylight Time	08/07/2018 01:29:40 PM Eastern Daylight Time	08/07/2018 01:30:35 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Henry Ford Tiered Access (HMO)	01	01		1			H2354	018	0	2019	Wayne, Oakland and Macomb counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	3-1;3-2;3-3;5;7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8a1;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b1;11b2;11c1;11c2;12;16b;17a;18a;	
H2354	019	0	1	01	01	H2354_019_0	5	1				07/17/2018	2019.01	07/17/2018 04:50:00 PM Eastern Daylight Time	06/01/2018 09:45:00 PM Eastern Daylight Time				07/18/2018 05:42:47 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Medical Only (HMO)	01	01		1			H2354	019	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2354	020	0	1	02	01	H2354_020_0	5	1				07/18/2018	2019.01	07/18/2018 03:13:25 PM Eastern Daylight Time	08/07/2018 01:29:41 PM Eastern Daylight Time	08/07/2018 01:30:36 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Option 1 (HMO-POS)	01	02		1			H2354	020	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	021	0	1	02	01	H2354_021_0	6	1				07/18/2018	2019.01	07/18/2018 03:16:07 PM Eastern Daylight Time	08/07/2018 01:29:43 PM Eastern Daylight Time	08/07/2018 01:30:36 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Option 2 (HMO-POS)	01	02		1			H2354	021	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	022	0	1	02	01	H2354_022_0	6	1				07/18/2018	2019.01	07/18/2018 03:18:35 PM Eastern Daylight Time	08/07/2018 01:29:44 PM Eastern Daylight Time	08/07/2018 01:30:37 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Option 3 (HMO-POS)	01	02		1			H2354	022	0	2019	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	024	0	1	01	01	H2354_024_0	6	1				07/17/2018	2019.01	07/17/2018 04:53:19 PM Eastern Daylight Time	08/07/2018 01:29:45 PM Eastern Daylight Time	08/07/2018 01:30:37 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Primary Choice Medicare (HMO)	01	01		1			H2354	024	0	2019	Southeast Michigan (Wayne, Oakland & Macomb)		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	025	0	1	01	01	H2354_025_0	5	1	2	1		07/17/2018	2019.01	07/17/2018 02:25:02 PM Eastern Daylight Time	08/07/2018 01:29:46 PM Eastern Daylight Time	08/07/2018 01:30:38 PM Eastern Daylight Time			08/07/2018 01:44:16 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Empowered Duals (HMO SNP)	01	01		1			H2354	025	0	2019	Genesee County		2		2			1	3		1		1	www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	801	0	1	01	01	H2354_801_0	3	1				06/01/2018	2019.01	06/01/2018 02:13:13 PM Eastern Daylight Time					06/04/2018 12:14:31 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Group (HMO)	01	01		1			H2354	801	0	2019	United States EG Area		1	318708	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2354	802	0	1	02	01	H2354_802_0	3	1				06/01/2018	2019.01	06/01/2018 02:15:25 PM Eastern Daylight Time					06/04/2018 12:14:31 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Group (HMO-POS)	01	02		1			H2354	802	0	2019	United States EG Area		1	63775	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1				
H2386	001	0	1	20	08	H2386_001_0	1	1				05/23/2018	2019.01	05/23/2018 01:12:20 PM Eastern Daylight Time		05/21/2018 12:30:38 PM Eastern Daylight Time			05/23/2018 01:20:40 PM Eastern Daylight Time	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	Appalachian Agency for Senior Citizens, Inc,	www.allcareforseniors.org	AllCARE for Seniors - Duals (PACE)	08	20		1			H2386	001	0	2019	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2						www.seniorscript.com	www.aasc.org										(866)828-7723		(276)964-7176		(866)828-7723		(276)964-7176										(800)656-2272		(276)964-5765		(800)656-2272		(276)964-5765																
H2386	002	0	1	20	08	H2386_002_0	1	1				05/23/2018	2019.01	05/23/2018 01:14:12 PM Eastern Daylight Time		05/21/2018 12:30:18 PM Eastern Daylight Time			05/23/2018 01:20:40 PM Eastern Daylight Time	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	Appalachian Agency for Senior Citizens, Inc,	www.allcareforseniors.org	AllCARE for Seniors - Medicare only (PACE)	08	20		1			H2386	002	0	2019	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2						www.seniorscript.com	www.aasc.org										(866)828-7723		(276)964-7176		(866)828-7723		(276)964-7176										(800)656-2272		(276)964-5765		(800)656-2272		(276)964-5765																
H2392	001	0	1	01	01	H2392_001_0	4	1		1		08/01/2018	2019.01	08/01/2018 03:18:06 PM Central Daylight Time	08/03/2018 04:07:56 PM Central Daylight Time	08/03/2018 04:08:24 PM Central Daylight Time			08/03/2018 04:13:17 PM Central Daylight Time	KANSAS SUPERIOR SELECT, INC.	Kansas Health Advantage	www.kansashealthadvantage.com	Kansas Health Advantage (HMO SNP)	01	01		1			H2392	001	0	2019	Central and East Kansas		2	8367	2			1	1	1				www.kansashealthadvantage.com	www.kansashealthadvantage.com	www.kansashealthadvantage.com	(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2400	001	0	1	01	01	H2400_001_0	2	1		1		08/02/2018	2019.01	08/02/2018 10:41:14 AM Central Daylight Time	08/06/2018 04:29:20 PM Central Daylight Time	08/06/2018 04:29:22 PM Central Daylight Time			08/06/2018 04:51:06 PM Central Daylight Time	SIGNATURE ADVANTAGE, LLC	Signature Advantage (HMO SNP)	www.signatureadvantageplan.com	Signature Advantage (HMO SNP)	01	01		1			H2400	001	0	2019	KY (partial)		2	8298	2			1	1	1				www.signatureadvantageplan.com	www.signatureadvantageplan.com	www.signatureadvantageplan.com	(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2406	001	0	1	04	01	H2406_001_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:53:48 PM Central Daylight Time	08/03/2018 09:58:43 AM Central Daylight Time	07/31/2018 06:29:20 PM Central Daylight Time			08/06/2018 10:43:58 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO SNP)	01	04		1			H2406	001	0	2019	Select Counties in Ohio		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	008	0	1	04	01	H2406_008_0	5	1				08/10/2018	2019.01	08/10/2018 10:06:36 AM Central Daylight Time	08/10/2018 09:53:09 AM Central Daylight Time	07/31/2018 06:29:42 PM Central Daylight Time			08/10/2018 02:02:35 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	008	0	2019	Select Counties in the Pan Handle of Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	009	0	1	04	01	H2406_009_0	3	1				08/02/2018	2019.01	08/02/2018 04:25:50 PM Central Daylight Time	08/03/2018 09:59:34 AM Central Daylight Time	07/31/2018 06:30:10 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	009	0	2019	Select counties in Southwest Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	010	0	1	04	01	H2406_010_0	3	1				08/02/2018	2019.01	08/02/2018 04:26:38 PM Central Daylight Time	08/03/2018 09:59:59 AM Central Daylight Time	07/31/2018 06:30:34 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	010	0	2019	Brevard, Orange, Osceola, and Seminole counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	011	0	1	04	01	H2406_011_0	3	1				08/02/2018	2019.01	08/02/2018 04:27:14 PM Central Daylight Time	08/03/2018 10:00:26 AM Central Daylight Time	07/31/2018 06:30:56 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	011	0	2019	Select counties in Tampa		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	012	0	1	04	01	H2406_012_0	3	1				08/02/2018	2019.01	08/02/2018 04:28:28 PM Central Daylight Time	08/03/2018 10:00:51 AM Central Daylight Time	07/31/2018 06:31:20 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	012	0	2019	Select Counties in Tallahassee		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	013	0	1	04	01	H2406_013_0	3	1				08/02/2018	2019.01	08/02/2018 04:29:37 PM Central Daylight Time	08/03/2018 10:01:17 AM Central Daylight Time	07/31/2018 06:31:42 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	013	0	2019	Select Counties in Jacksonville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	014	0	1	04	01	H2406_014_0	3	1				08/02/2018	2019.01	08/02/2018 04:30:16 PM Central Daylight Time	08/03/2018 10:01:43 AM Central Daylight Time	07/31/2018 06:32:06 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	014	0	2019	Select Counties in Gainesville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	015	0	1	04	01	H2406_015_0	3	1				08/02/2018	2019.01	08/02/2018 04:30:56 PM Central Daylight Time	08/03/2018 10:02:08 AM Central Daylight Time	07/31/2018 06:32:30 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	015	0	2019	Citrus and Levy Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	016	0	1	04	01	H2406_016_0	3	1				08/02/2018	2019.01	08/02/2018 04:31:57 PM Central Daylight Time	08/03/2018 10:02:34 AM Central Daylight Time	07/31/2018 06:32:52 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	016	0	2019	Lake, Marion, and Sumter Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	017	0	1	04	01	H2406_017_0	3	1				08/02/2018	2019.01	08/02/2018 04:32:37 PM Central Daylight Time	08/03/2018 10:02:59 AM Central Daylight Time	07/31/2018 06:33:14 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	017	0	2019	Select Counties in St. Lucie		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	018	0	1	04	01	H2406_018_0	4	1				08/02/2018	2019.01	08/02/2018 04:33:06 PM Central Daylight Time	08/03/2018 10:03:24 AM Central Daylight Time	07/31/2018 06:33:38 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	018	0	2019	Broward, Miami-Dade, and Palm Beach Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	019	0	1	04	01	H2406_019_0	3	1				08/02/2018	2019.01	08/02/2018 04:33:47 PM Central Daylight Time	08/03/2018 10:03:49 AM Central Daylight Time	07/31/2018 06:34:00 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2406	019	0	2019	DeSoto, Hardee, and Highlands Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	020	0	1	04	01	H2406_020_0	4	1				05/24/2018	2019.01	05/24/2018 12:00:41 PM Central Daylight Time	08/03/2018 10:04:16 AM Central Daylight Time	07/31/2018 06:34:22 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Sync (PPO)	01	04		1			H2406	020	0	2019	Palm Beach County		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	805	0	1	04	01	H2406_805_0	1	1				05/25/2018	2019.01	05/25/2018 03:25:16 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	805	0	2019	Nationwide		1	21516	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	806	0	1	04	01	H2406_806_0	1	1				05/25/2018	2019.01	05/25/2018 03:25:44 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	806	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2406	807	0	1	04	01	H2406_807_0	1	1				05/25/2018	2019.01	05/25/2018 03:27:42 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	807	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	808	0	2	04	01	H2406_808_0	1	1				05/25/2018	2019.01	05/25/2018 03:29:09 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	808	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	809	0	2	04	01	H2406_809_0	1	1				05/25/2018	2019.01	05/25/2018 03:30:06 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	809	0	2019	Nationwide		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2406	810	0	2	04	01	H2406_810_0	1	1				05/25/2018	2019.01	05/25/2018 03:31:39 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	810	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	811	0	1	04	01	H2406_811_0	1	1				05/25/2018	2019.01	05/25/2018 03:41:10 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	811	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	812	0	1	04	01	H2406_812_0	1	1				05/25/2018	2019.01	05/25/2018 03:39:40 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	812	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	813	0	1	04	01	H2406_813_0	1	1				05/25/2018	2019.01	05/25/2018 03:43:35 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	813	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	814	0	1	04	01	H2406_814_0	1	1				05/25/2018	2019.01	05/25/2018 03:43:19 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	814	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2406	815	0	1	04	01	H2406_815_0	1	1				05/25/2018	2019.01	05/25/2018 03:45:28 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	815	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	816	0	2	04	01	H2406_816_0	1	1				05/25/2018	2019.01	05/25/2018 03:48:47 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	816	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	817	0	2	04	01	H2406_817_0	1	1				05/25/2018	2019.01	05/25/2018 03:49:57 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	817	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2406	818	0	2	04	01	H2406_818_0	1	1				05/25/2018	2019.01	05/25/2018 03:50:35 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	818	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	819	0	1	04	01	H2406_819_0	1	1				05/25/2018	2019.01	05/25/2018 03:51:17 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	819	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	820	0	1	04	01	H2406_820_0	1	1				05/25/2018	2019.01	05/25/2018 03:52:36 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	820	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	821	0	1	04	01	H2406_821_0	1	1				05/25/2018	2019.01	05/25/2018 03:53:22 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	821	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2406	822	0	1	04	01	H2406_822_0	1	1				05/25/2018	2019.01	05/25/2018 03:54:42 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	822	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	823	0	1	04	01	H2406_823_0	1	1				05/25/2018	2019.01	05/25/2018 03:55:56 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	823	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	824	0	1	04	01	H2406_824_0	1	1				05/25/2018	2019.01	05/25/2018 03:56:35 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	824	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	825	0	1	04	01	H2406_825_0	1	1				05/25/2018	2019.01	05/25/2018 03:57:54 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	825	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	826	0	1	04	01	H2406_826_0	1	1				05/25/2018	2019.01	05/25/2018 03:58:48 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	826	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	827	0	1	04	01	H2406_827_0	1	1				05/25/2018	2019.01	05/25/2018 04:04:03 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	827	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	828	0	2	04	01	H2406_828_0	1	1				05/25/2018	2019.01	05/25/2018 04:04:38 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	828	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	829	0	1	04	01	H2406_829_0	1	1				05/25/2018	2019.01	05/25/2018 04:05:27 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	829	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2406	830	0	1	04	01	H2406_830_0	1	1				05/25/2018	2019.01	05/25/2018 04:06:15 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	830	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	831	0	1	04	01	H2406_831_0	1	1				05/25/2018	2019.01	05/25/2018 04:06:42 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	831	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	832	0	1	04	01	H2406_832_0	1	1				05/31/2018	2019.01	05/31/2018 11:42:57 AM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	832	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	833	0	1	04	01	H2406_833_0	1	1				05/25/2018	2019.01	05/25/2018 04:08:08 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	833	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2406	834	0	1	04	01	H2406_834_0	1	1				05/25/2018	2019.01	05/25/2018 04:09:00 PM Central Daylight Time					06/02/2018 12:27:22 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	834	0	2019	Nationwide		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2416	001	0	1	01	01	H2416_001_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 09:49:59 AM Central Daylight Time	07/31/2018 04:22:51 PM Central Daylight Time	07/31/2018 04:26:13 PM Central Daylight Time			07/31/2018 04:58:11 PM Central Daylight Time	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	PrimeWest Health	www.primewest.org/pwshc	PrimeWest Senior Health Complete (HMO SNP)	01	01		1			H2416	001	0	2019	Northern, west central, and southwestern Minnesota		2	23244	2			1	3		1		1	https://primewest.org/drug-search	https://primewest.org/pharmacy-search	https://www.primewest.org/find-a-health-care-provider	(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1					1				
H2417	001	0	1	01	01	H2417_001_0	3	1	2	1		08/06/2018	2019.01	08/06/2018 04:49:47 PM Central Daylight Time	08/06/2018 04:09:39 PM Central Daylight Time	08/06/2018 04:04:50 PM Central Daylight Time			08/06/2018 05:02:25 PM Central Daylight Time	ITASCA MEDICAL CARE	Itasca Medical Care/IMCare Classic	www.imcare.org	IMCare Classic (HMO SNP)	01	01		1			H2417	001	0	2019	Itasca County		2	5680	2			1	3		1		1	http://www.caremark.com/wps/portal	http://www.imcare.org	http://www.imcare.org	(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;9b;9c;9d;10a;11a;11b;11c;12;18a;	1	2;5;6;7c;7d;7e;7f;7g;7h;7i;9b;9c;9d;12;18a;	2					1				
H2419	001	0	1	01	01	H2419_001_0	3	1	2	1		05/31/2018	2019.01	05/31/2018 11:01:47 AM Central Daylight Time	08/01/2018 03:35:15 PM Central Daylight Time	08/01/2018 02:47:07 PM Central Daylight Time			08/02/2018 03:49:01 PM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	SeniorCare Complete (HMO SNP)	01	01		1			H2419	001	0	2019	Select Counties in Minnesota		2	23725	1	1		1	3		1		1	www.mnscha.org	www.mnscha.org	www.mnscha.org	(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2422	002	0	1	01	01	H2422_002_0	4	1	2	1		08/09/2018	2019.01	08/09/2018 01:47:24 PM Central Daylight Time	08/09/2018 12:56:59 PM Central Daylight Time	08/02/2018 08:27:16 AM Central Daylight Time			08/09/2018 01:51:39 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/msho	HealthPartners Minnesota Senior Health Options (HMO SNP)	01	01		1			H2422	002	0	2019	Minneapolis/St. Paul Metro Area		2		2			1	3		1		1	healthpartners.com/msho	healthpartners.com/medicarerx	healthpartners.com/msho	(888)820-4285		(952)967-7029		(877)713-8215		(952)883-5050		(888)820-4285		(952)967-7029		(877)713-8215		(952)883-5050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2425	001	0	1	01	01	H2425_001_0	7	1	2	1		07/25/2018	2019.01	07/25/2018 02:50:42 PM Central Daylight Time	08/02/2018 06:03:28 PM Central Daylight Time	08/02/2018 05:44:50 PM Central Daylight Time			08/03/2018 02:45:51 PM Central Daylight Time	BLUE PLUS	Blue Plus	www.bluecrossmn.com/secureblue	SecureBlue (HMO SNP)	01	01		1			H2425	001	0	2019	62 Counties within the State of Minnesota		2	112275	2			1	3		1		1	www.myprime.com	www.myprime.com	www.bluecrossmn.com/secureblue	(888)877-6424		(888)877-6424		(866)477-1584		(651)662-3584		(888)877-6424		(888)877-6424		(866)477-1584		(651)662-3584		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2446	001	0	1	02	01	H2446_001_0	10	1				07/26/2018	2019.01	07/26/2018 02:26:15 PM Central Daylight Time	08/01/2018 03:08:38 PM Central Daylight Time	08/02/2018 01:55:48 PM Central Daylight Time			08/03/2018 02:52:42 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Strive Medicare Advantage Choice (HMO-POS)	01	02		1			H2446	001	0	2019	Eight County Metro		2	10109	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com			(855)373-2583		(855)579-7658		(651)662-9949		(855)373-2583		(855)373-2583		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2446	002	0	1	02	01	H2446_002_0	10	1				07/26/2018	2019.01	07/26/2018 02:27:21 PM Central Daylight Time	08/01/2018 03:09:44 PM Central Daylight Time	08/02/2018 01:55:48 PM Central Daylight Time			08/03/2018 02:52:42 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Strive Medicare Advantage Complete (HMO-POS)	01	02		1			H2446	002	0	2019	Eight County Metro		2	7802	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com			(855)373-2583		(855)579-7658		(651)662-9949		(855)373-2583		(855)373-2583		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	001	0	1	18	06	H2450_001_0	4	1				05/25/2018	2019.01	05/25/2018 02:31:53 PM Central Daylight Time		08/01/2018 08:29:53 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Basic w/Rx 2 (Cost)	06	18		1			H2450	001	0	2019	Select Counties in MN		2	16889	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	002	0	1	18	06	H2450_002_0	4	1				05/25/2018	2019.01	05/25/2018 02:32:57 PM Central Daylight Time		08/01/2018 08:30:27 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Enhanced w/Rx 2 (Cost)	06	18		1			H2450	002	0	2019	Select Counties in MN		2	15016	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	007	0	1	18	06	H2450_007_0	4	1				05/25/2018	2019.01	05/25/2018 02:33:46 PM Central Daylight Time		08/01/2018 01:31:35 PM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Thrift w/Rx (Cost)	06	18		1			H2450	007	0	2019	All of SD, plus select counties in MN, ND and WI		2	4264	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	016	0	1	18	06	H2450_016_0	4	1				05/25/2018	2019.01	05/25/2018 02:34:54 PM Central Daylight Time		08/01/2018 08:31:40 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Basic w/Rx (Cost)	06	18		1			H2450	016	0	2019	Select Counties in MN		2	35426	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	017	0	1	18	06	H2450_017_0	4	1				05/25/2018	2019.01	05/25/2018 03:13:28 PM Central Daylight Time		08/01/2018 08:32:19 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Enhanced w/Rx (Cost)	06	18		1			H2450	017	0	2019	Select Counties in MN		2	8551	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	022	0	1	18	06	H2450_022_0	4	1				05/31/2018	2019.01	05/31/2018 03:37:54 PM Central Daylight Time		08/01/2018 08:32:54 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Value w/Rx (Cost)	06	18		1			H2450	022	0	2019	Select Counties in MN		2	5831	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	030	0	1	18	06	H2450_030_0	3	1				05/24/2018	2019.01	05/24/2018 09:22:55 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Thrift (Cost)	06	18		1			H2450	030	0	2019	All of SD & select counties in IA, MN, ND, NE & WI		2	7164	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	031	0	1	18	06	H2450_031_0	3	1				05/24/2018	2019.01	05/24/2018 09:23:25 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Value (Cost)	06	18		1			H2450	031	0	2019	Select Counties in MN		2	5926	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	032	0	1	18	06	H2450_032_0	3	1				05/24/2018	2019.01	05/24/2018 09:23:53 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Basic (Cost)	06	18		1			H2450	032	0	2019	Select Counties in MN		2	33951	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	033	0	1	18	06	H2450_033_0	3	1				05/24/2018	2019.01	05/24/2018 09:24:36 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Enhanced (Cost)	06	18		1			H2450	033	0	2019	Select Counties in MN		2	14835	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	034	0	1	18	06	H2450_034_0	3	1				05/25/2018	2019.01	05/25/2018 02:28:16 PM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	034	0	2019	All of SD, plus select counties in ND		2	358906	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	035	0	1	18	06	H2450_035_0	4	1				05/25/2018	2019.01	05/25/2018 03:14:40 PM Central Daylight Time		08/01/2018 08:33:28 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Core w/Rx (Cost)	06	18		1			H2450	035	0	2019	All of SD, plus select counties in ND		2	62178	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	036	0	1	18	06	H2450_036_0	3	1				05/24/2018	2019.01	05/24/2018 09:26:26 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	036	0	2019	All of SD, plus select counties in ND		2	133310	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	037	0	1	18	06	H2450_037_0	4	1				05/25/2018	2019.01	05/25/2018 03:16:58 PM Central Daylight Time		08/01/2018 09:29:59 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Premier w/Rx (Cost)	06	18		1			H2450	037	0	2019	All of SD, plus select counties in ND		2	17145	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	038	0	1	18	06	H2450_038_0	3	1				05/24/2018	2019.01	05/24/2018 11:05:03 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Focus (Cost)	06	18		1			H2450	038	0	2019	Select counties in WI		2	162245	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	039	0	1	18	06	H2450_039_0	4	1				05/25/2018	2019.01	05/25/2018 03:17:35 PM Central Daylight Time		08/01/2018 08:34:49 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Focus w/Rx (Cost)	06	18		1			H2450	039	0	2019	Select counties in WI		2	92785	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	040	0	1	18	06	H2450_040_0	3	1				05/24/2018	2019.01	05/24/2018 11:08:53 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Total (Cost)	06	18		1			H2450	040	0	2019	Select counties in WI		2	34126	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	041	0	1	18	06	H2450_041_0	5	1				05/30/2018	2019.01	05/30/2018 10:03:38 AM Central Daylight Time		08/01/2018 08:35:27 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Total w/Rx (Cost)	06	18		1			H2450	041	0	2019	Select counties in WI		2	24919	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	042	0	1	18	06	H2450_042_0	3	1				05/28/2018	2019.01	05/28/2018 11:11:15 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	042	0	2019	Select counties in Iowa		2	4995	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	043	0	1	18	06	H2450_043_0	3	1				05/25/2018	2019.01	05/25/2018 02:29:13 PM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	043	0	2019	Select counties in Nebraska		2	1330	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	044	0	1	18	06	H2450_044_0	3	1				05/24/2018	2019.01	05/24/2018 09:25:03 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Prime Solution Standard (Cost)	06	18		1			H2450	044	0	2019	Select counties in MN		2	6000	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	801	0	1	18	06	H2450_801_0	3	1				05/24/2018	2019.01	05/24/2018 09:22:01 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	medica.com	Medica Group Prime Solution w/Rx (Cost)	06	18		1			H2450	801	0	2019	All of SD, plus select Counties in MN, ND and WI		1	9935	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2456	002	0	1	01	01	H2456_002_0	5	1	2	1		08/07/2018	2019.01	08/07/2018 01:04:29 PM Central Daylight Time	08/07/2018 09:06:05 AM Central Daylight Time	08/02/2018 04:07:02 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare's MSHO	www.ucare.org	UCare's Minnesota Senior Health Options (HMO SNP)	01	01		1			H2456	002	0	2019	Twin Cities Metropolitan area and Greater MN		2		2			1	3		1		1	www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(866)280-7202		(612)676-6868		(800)707-1711		(612)676-3554		(866)280-7202		(612)676-6868		(800)707-1711		(612)676-3554		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2458	002	0	1	01	01	H2458_002_0	9	1	2	1		08/08/2018	2019.01	08/08/2018 01:24:13 PM Central Daylight Time	08/08/2018 10:03:14 AM Central Daylight Time	08/01/2018 08:36:53 AM Central Daylight Time			08/09/2018 10:10:53 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica DUAL Solution (HMO SNP)	01	01		1			H2458	002	0	2019	Specific Minnesota Counties		2	145452	2			1	3		1		1	medica.com/Members	medica.com/Members	medica.com/Members	(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2459	001	0	1	02	01	H2459_001_0	4	1				07/10/2018	2019.01	07/10/2018 01:38:07 PM Central Daylight Time	06/03/2018 02:20:09 PM Central Daylight Time				07/11/2018 12:24:42 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Value (HMO-POS)	01	02		1			H2459	001	0	2019	State of Minnesota		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500										(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810										2					2					2	2			
H2459	020	0	1	02	01	H2459_020_0	4	1				08/07/2018	2019.01	08/07/2018 11:30:36 AM Central Daylight Time	08/07/2018 09:09:21 AM Central Daylight Time	08/02/2018 04:08:15 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Prime (HMO-POS)	01	02		1			H2459	020	0	2019	Twin Cities Metropolitan Area		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	021	1	1	02	01	H2459_021_1	6	1				07/06/2018	2019.01	07/06/2018 05:23:54 PM Central Daylight Time	08/07/2018 09:14:36 AM Central Daylight Time	08/02/2018 04:09:16 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	1	2019	44 Counties	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	021	2	1	02	01	H2459_021_2	4	1				07/06/2018	2019.01	07/06/2018 05:24:17 PM Central Daylight Time	08/07/2018 09:53:26 AM Central Daylight Time	08/02/2018 04:12:25 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	2	2019	44 Counties	Northern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	021	3	1	02	01	H2459_021_3	4	1				07/06/2018	2019.01	07/06/2018 05:24:43 PM Central Daylight Time	08/07/2018 09:18:44 AM Central Daylight Time	08/02/2018 04:13:38 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	3	2019	44 Counties	Southern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	023	1	1	02	01	H2459_023_1	6	1				08/07/2018	2019.01	08/07/2018 11:33:28 AM Central Daylight Time	08/07/2018 09:23:12 AM Central Daylight Time	08/02/2018 04:14:38 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Essentials Rx (HMO-POS)	01	02		1			H2459	023	1	2019	46 Counties	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	023	2	1	02	01	H2459_023_2	6	1				08/07/2018	2019.01	08/07/2018 11:35:03 AM Central Daylight Time	08/07/2018 09:25:26 AM Central Daylight Time	08/02/2018 04:15:46 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Essentials Rx (HMO-POS)	01	02		1			H2459	023	2	2019	46 Counties	Northern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	024	0	1	02	01	H2459_024_0	7	1				08/08/2018	2019.01	08/08/2018 10:47:28 AM Central Daylight Time	08/07/2018 09:27:37 AM Central Daylight Time	08/02/2018 04:16:57 PM Central Daylight Time			08/08/2018 10:48:03 AM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Standard (HMO-POS)	01	02		1			H2459	024	0	2019	Southern Minnesota		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	025	1	1	02	01	H2459_025_1	5	1				07/06/2018	2019.01	07/06/2018 05:20:39 PM Central Daylight Time	08/07/2018 09:49:16 AM Central Daylight Time	08/02/2018 03:58:41 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Total (HMO-POS)	01	02		1			H2459	025	1	2019	State of Minnesota	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	025	2	1	02	01	H2459_025_2	5	1				06/04/2018	2019.01	06/04/2018 10:15:16 PM Central Daylight Time	08/07/2018 09:32:37 AM Central Daylight Time	08/02/2018 03:59:54 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Total (HMO-POS)	01	02		1			H2459	025	2	2019	State of Minnesota	Northern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	025	3	1	02	01	H2459_025_3	5	1				07/06/2018	2019.01	07/06/2018 05:21:07 PM Central Daylight Time	08/07/2018 09:35:26 AM Central Daylight Time	08/02/2018 04:04:11 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Total (HMO-POS)	01	02		1			H2459	025	3	2019	State of Minnesota	Southern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	026	1	1	02	01	H2459_026_1	6	1				08/07/2018	2019.01	08/07/2018 11:38:35 AM Central Daylight Time	08/07/2018 09:37:41 AM Central Daylight Time	08/02/2018 04:05:09 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	1	2019	55 Counties	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	026	3	1	02	01	H2459_026_3	5	1				08/07/2018	2019.01	08/07/2018 11:40:04 AM Central Daylight Time	08/07/2018 09:40:05 AM Central Daylight Time	08/02/2018 04:06:07 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	3	2019	55 Counties	Southern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	801	0	1	02	01	H2459_801_0	2	1				05/31/2018	2019.01	05/31/2018 04:31:20 PM Central Daylight Time					06/04/2018 04:20:09 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	Group UCare (HMO-POS)	01	02		1			H2459	801	0	2019	Minnesota and 26 Wisconsin Counties		1	64823	2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(877)447-4385		(612)676-6840		(877)598-6574		(612)676-6900		(877)447-4385		(612)676-6840		(877)598-6574		(612)676-6900		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					1	2		2		1	2			
H2461	005	0	1	18	06	H2461_005_0	5	1				07/26/2018	2019.01	07/26/2018 02:28:13 PM Central Daylight Time					07/26/2018 03:18:33 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Core Plan (Cost)	06	18		1			H2461	005	0	2019	21 County region		2	8558	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	006	0	1	18	06	H2461_006_0	6	1				08/29/2018	2019.01	08/29/2018 02:57:55 PM Central Daylight Time					08/29/2018 03:13:02 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Choice Plan (Cost)	06	18		1			H2461	006	0	2019	21 County Region		2	113944	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	007	0	1	18	06	H2461_007_0	6	1				09/04/2018	2019.01	09/04/2018 12:08:45 PM Central Daylight Time					09/04/2018 12:10:33 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Complete Plan (Cost)	06	18		1			H2461	007	0	2019	21 County region		2	233855	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	008	0	1	18	06	H2461_008_0	9	1				07/26/2018	2019.01	07/26/2018 02:36:02 PM Central Daylight Time		08/02/2018 01:56:06 PM Central Daylight Time			08/03/2018 02:57:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Core Plan with Rx (Cost)	06	18		1			H2461	008	0	2019	21 County Region		2	5692	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2461	009	0	1	18	06	H2461_009_0	10	1				08/29/2018	2019.01	08/29/2018 02:59:14 PM Central Daylight Time		08/02/2018 01:56:06 PM Central Daylight Time			08/29/2018 03:13:02 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Choice Plan with Rx (Cost)	06	18		1			H2461	009	0	2019	21 County Region		2	56155	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2461	010	0	1	18	06	H2461_010_0	10	1				08/29/2018	2019.01	08/29/2018 02:59:33 PM Central Daylight Time		08/02/2018 01:56:06 PM Central Daylight Time			08/29/2018 03:13:02 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Complete Plan with Rx (Cost)	06	18		1			H2461	010	0	2019	21 County Region		2	67061	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2462	004	0	1	18	06	H2462_004_0	6	1				08/03/2018	2019.01	08/03/2018 12:06:19 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Basic (Cost)	06	18		1			H2462	004	0	2019	Select MN Counties, Duluth Area & Western WI		2	468	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	010	0	1	18	06	H2462_010_0	6	1				08/03/2018	2019.01	08/03/2018 12:06:58 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate (Cost)	06	18		1			H2462	010	0	2019	21 MN Counties Including the Duluth Area		2	3336	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	016	0	1	18	06	H2462_016_0	5	1				08/03/2018	2019.01	08/03/2018 03:51:27 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance (Cost)	06	18		1			H2462	016	0	2019	Select MN Counties, Duluth Area & Western WI		2	13056	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	017	0	1	18	06	H2462_017_0	8	1				08/03/2018	2019.01	08/03/2018 03:51:03 PM Central Daylight Time		08/03/2018 04:41:10 PM Central Daylight Time			08/03/2018 04:42:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance with Rx (Cost)	06	18		1			H2462	017	0	2019	Select MN Counties, Duluth Area & Western WI		2	756	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2462	018	0	1	18	06	H2462_018_0	5	1				08/03/2018	2019.01	08/03/2018 12:08:15 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital (Cost)	06	18		1			H2462	018	0	2019	Select MN Counties, Duluth Area & Western WI		2	2388	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	019	0	1	18	06	H2462_019_0	8	1				07/02/2018	2019.01	07/02/2018 04:53:34 PM Central Daylight Time		08/03/2018 04:41:19 PM Central Daylight Time			08/03/2018 04:42:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital with Rx (Cost)	06	18		1			H2462	019	0	2019	Select MN Counties, Duluth Area & Western WI		2	102864	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2462	022	0	1	18	06	H2462_022_0	6	1				08/03/2018	2019.01	08/03/2018 04:25:18 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Basic (Cost)	06	18		1			H2462	022	0	2019	Certain counties in North Dakota and South Dakota		2	500	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	023	0	1	18	06	H2462_023_0	6	1				08/03/2018	2019.01	08/03/2018 12:09:17 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Vital (Cost)	06	18		1			H2462	023	0	2019	Certain counties in North Dakota and South Dakota		2	1900	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	024	0	1	18	06	H2462_024_0	6	1				08/03/2018	2019.01	08/03/2018 12:09:44 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Active (Cost)	06	18		1			H2462	024	0	2019	Certain counties in North Dakota and South Dakota		2	1900	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	025	0	1	18	06	H2462_025_0	6	1				08/03/2018	2019.01	08/03/2018 12:10:02 PM Central Daylight Time					08/03/2018 04:26:09 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Ultimate (Cost)	06	18		1			H2462	025	0	2019	Certain counties in North Dakota and South Dakota		2	1900	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	801	0	1	18	06	H2462_801_0	1	1				05/31/2018	2019.01	05/31/2018 01:18:33 PM Central Daylight Time					06/01/2018 05:27:14 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree Group Calendar Year (Cost)	06	18		1			H2462	801	0	2019	Select Counties in MN, WI, ND, and SD		1	11700	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2462	802	0	1	18	06	H2462_802_0	1	1				05/31/2018	2019.01	05/31/2018 01:18:43 PM Central Daylight Time					06/01/2018 05:27:14 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree Group Non-Calendar Year (Cost)	06	18		1			H2462	802	0	2019	Select Counties in MN, WI, ND, and SD		1	0	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2463	001	0	1	01	01	H2463_001_0	4	1				07/02/2018	2019.01	07/02/2018 04:30:32 PM Eastern Daylight Time	06/01/2018 03:33:09 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2463-001 (HMO)	01	01		1			H2463	001	0	2019	Pinal County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2463	002	0	1	01	01	H2463_002_0	4	1				07/02/2018	2019.01	07/02/2018 04:31:49 PM Eastern Daylight Time	06/01/2018 03:21:21 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2463-002 (HMO)	01	01		1			H2463	002	0	2019	Yuma County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2486	003	0	1	01	01	H2486_003_0	4	1				07/02/2018	2019.01	07/02/2018 02:25:28 PM Eastern Daylight Time	06/01/2018 02:31:11 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:35:12 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2486-003 (HMO)	01	01		1			H2486	003	0	2019	Davis, Salt Lake, Utah and Weber counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2486	801	0	1	01	01	H2486_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:28:08 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	801	0	2019	Select counties in Utah		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2486	802	0	1	01	01	H2486_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:30:16 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	802	0	2019	Select counties in Utah		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2491	004	0	1	01	01	H2491_004_0	3	1	2	1		08/03/2018	2019.01	08/03/2018 12:15:43 PM Eastern Daylight Time	08/06/2018 05:08:50 PM Eastern Daylight Time	08/01/2018 02:27:39 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare Health Plan	www.ohanahealthplan.com/medicare	'Ohana Liberty (HMO SNP)	01	01		1			H2491	004	0	2019	Hawaii, Honolulu, Kauai, Maui Counties		2	62759	2			1	3		1		1	www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	(877)457-7621		(877)457-7621		(800)265-8171		(800)265-8171		(877)457-7621		(877)457-7621		(800)265-8171		(800)265-8171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	006	0	1	01	01	H2491_006_0	4	1	2	1		07/12/2018	2019.01	07/12/2018 03:29:31 PM Eastern Daylight Time	08/06/2018 05:09:35 PM Eastern Daylight Time	08/01/2018 02:28:00 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare Health Plan	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H2491	006	0	2019	Select Counties in LA		2	82404	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9488		(866)530-9488		(866)527-0056		(866)527-0056		(866)530-9488		(866)530-9488		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	007	0	1	01	01	H2491_007_0	5	1				08/03/2018	2019.01	08/03/2018 12:13:40 PM Eastern Daylight Time	08/06/2018 05:10:18 PM Eastern Daylight Time	08/01/2018 02:28:21 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare Health Plan	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H2491	007	0	2019	Select Counties in LA		2	73955	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)804-5926		(866)804-5926		(866)527-0056		(866)527-0056		(866)804-5926		(866)804-5926		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	008	0	1	01	01	H2491_008_0	4	1	2	1		07/12/2018	2019.01	07/12/2018 03:33:58 PM Eastern Daylight Time	08/06/2018 05:11:02 PM Eastern Daylight Time	08/01/2018 02:28:42 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare Health Plan	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H2491	008	0	2019	Select Counties in LA		2	53105	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9488		(866)530-9488		(866)527-0056		(866)527-0056		(866)530-9488		(866)530-9488		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	009	0	1	01	01	H2491_009_0	5	1				08/03/2018	2019.01	08/03/2018 12:14:22 PM Eastern Daylight Time	08/06/2018 05:11:47 PM Eastern Daylight Time	08/01/2018 02:29:03 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare Health Plan	www.ohanahealthplan.com/medicare	'Ohana Value (HMO)	01	01		1			H2491	009	0	2019	Honolulu		2	8975	2			2						www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	(888)505-1201		(888)505-1201		(800)265-8171		(800)265-8171		(888)505-1201		(888)505-1201		(800)265-8171		(800)265-8171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7c;7d;7f;7g;7i;8b3;16b;17a;18a;	
H2491	010	0	1	01	01	H2491_010_0	5	1				07/12/2018	2019.01	07/12/2018 03:44:30 PM Eastern Daylight Time	08/06/2018 05:12:32 PM Eastern Daylight Time	08/01/2018 02:29:24 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare Health Plan	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H2491	010	0	2019	Selected Counties		2	1905	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)804-5926		(866)804-5926		(866)527-0056		(866)527-0056		(866)804-5926		(866)804-5926		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2506	001	0	1	48	05	H2506_001_0	4	1				08/23/2018	2019.01	08/23/2018 12:23:28 PM Central Daylight Time					08/23/2018 12:26:32 PM Central Daylight Time	AETNA BETTER HEALTH, INC. (IL)	Aetna Better Health Premier Plan	www.aetnabetterhealth.com/illinois	Aetna Better Health Premier Plan (Medicare-Medicaid Plan)	05	48		1			H2506	001	0	2019	Metro Chicago Area		2	84000	2			2						http://www.aetnabetterhealth.com/illinois	http://www.aetnabetterhealth.com/illinois	http://www.aetnabetterhealth.com/illinois	(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2531	001	0	1	48	05	H2531_001_0	3	1				08/21/2018	2019.01	08/21/2018 12:17:30 PM Eastern Daylight Time					08/21/2018 12:24:37 PM Eastern Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	UnitedHealthcare Community Plan	www.uhccommunityplan.com	UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)	05	48		1			H2531	001	0	2019	Select Counties in Ohio		2	12	2			2						www.optumrx.com	www.uhccommunityplan.com	www.uhccommunityplan.com	(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2533	001	0	1	48	05	H2533_001_0	2	1				06/29/2018	2019.01	06/29/2018 09:10:13 AM Pacific Daylight Time					06/29/2018 01:34:05 PM Pacific Daylight Time	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Molina Healthcare of South Carolina	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H2533	001	0	2019	South Carolina		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5831		(855)735-5831		(855)701-4887		(855)701-4887		(855)735-5831		(855)735-5831		(855)701-4887		(855)701-4887		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2537	001	0	1	20	08	H2537_001_0	1	1				05/23/2018	2019.01	05/23/2018 01:05:27 PM Eastern Daylight Time		05/22/2018 01:09:17 PM Eastern Daylight Time			05/23/2018 01:15:14 PM Eastern Daylight Time	SPIRITTRUST LUTHERAN LIFE	SpiriTrust Lutheran LIFE	www.spiritrustlutheranlife.org	SpiriTrust Lutheran LIFE - Dual (PACE)	08	20		1			H2537	001	0	2019	Franklin, Cumberland, Perry Counties		2		2			2						www.norlandavenuepharmacy.com	www.lifelutheranservices.org										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433																
H2537	002	0	1	20	08	H2537_002_0	1	1				05/23/2018	2019.01	05/23/2018 01:06:13 PM Eastern Daylight Time		05/22/2018 01:08:57 PM Eastern Daylight Time			05/23/2018 01:15:14 PM Eastern Daylight Time	SPIRITTRUST LUTHERAN LIFE	SpiriTrust Lutheran LIFE	www.spiritrustlutheranlife.org	SpiriTrust Lutheran LIFE  - Medicare Only (PACE)	08	20		1			H2537	002	0	2019	Franklin, Cumberland, Perry Counties		2		2			2						www.norlandavenuepharmacy.com	www.lifelutheranservices.org										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433																
H2563	003	0	1	01	01	H2563_003_0	8	1				07/16/2018	2019.01	07/16/2018 02:05:06 PM Eastern Daylight Time	08/03/2018 03:56:33 PM Eastern Daylight Time	08/03/2018 04:17:12 PM Eastern Daylight Time			08/06/2018 05:40:30 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	003	0	2019	Hampton Roads, Virginia		2	22439	2			2						www.optimahealth.com	www.optimahealth.com/medicare	HTTP://optimahealth.prismisp.com/	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	004	0	1	01	01	H2563_004_0	7	1	2	1		08/06/2018	2019.01	08/06/2018 04:54:47 PM Eastern Daylight Time	08/03/2018 03:58:07 PM Eastern Daylight Time	08/03/2018 04:16:17 PM Eastern Daylight Time			08/06/2018 05:40:30 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Community Complete (HMO SNP)	01	01		1			H2563	004	0	2019	Virginia		2	12000	2			1	3		1		2	www.optimahealth.com	www.optimahealth.com/medicare	HTTP://optimahealth.prismisp.com/	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	005	1	1	01	01	H2563_005_1	8	1				08/06/2018	2019.01	08/06/2018 04:56:38 PM Eastern Daylight Time	08/03/2018 04:02:54 PM Eastern Daylight Time	08/03/2018 04:12:38 PM Eastern Daylight Time			08/06/2018 05:40:30 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	005	1	2019	Hampton Roads, Virginia	Hampton Roads, VA - Southside	2	21323	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.com/	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	005	2	1	01	01	H2563_005_2	8	1				08/06/2018	2019.01	08/06/2018 04:56:58 PM Eastern Daylight Time	08/03/2018 04:06:56 PM Eastern Daylight Time	08/03/2018 04:14:38 PM Eastern Daylight Time			08/06/2018 05:40:30 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	005	2	2019	Hampton Roads, Virginia	Hampton Roads, VA - Peninsula	2	2587	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.com/	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2591	801	0	1	04	01	H2591_801_0	2	1				06/05/2018	2019.01	06/05/2018 09:31:58 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Medicare Employer PPO (PPO)	01	04		1			H2591	801	0	2019	Health Alliance Medicare		1	120	1	1		2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H2591	802	0	1	04	01	H2591_802_0	2	1				06/05/2018	2019.01	06/05/2018 09:32:05 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (PPO)	01	04		1			H2591	802	0	2019	Health Alliance Medicare		1	1200	1	1		2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2591	803	0	1	04	01	H2591_803_0	2	1				06/05/2018	2019.01	06/05/2018 09:32:12 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (non calendar) (PPO)	01	04		1			H2591	803	0	2019	Health Alliance Medicare  (non calendar)		1	0	1	1		2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H2593	001	0	1	01	01	H2593_001_0	9	1				07/26/2018	2019.01	07/26/2018 11:52:56 AM Pacific Daylight Time	08/01/2018 04:07:17 PM Pacific Daylight Time	07/31/2018 03:17:19 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore Classic (HMO)	01	01		1			H2593	001	0	2019	Pima County		2	56954	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	003	0	1	01	01	H2593_003_0	8	1		1		08/01/2018	2019.01	08/01/2018 02:15:04 PM Pacific Daylight Time	08/01/2018 04:10:14 PM Pacific Daylight Time	07/31/2018 03:17:41 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore Care To You (HMO SNP)	01	01		1			H2593	003	0	2019	Pima County		2	14961	2			1	1	3				www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	005	0	1	01	01	H2593_005_0	8	1		1		07/26/2018	2019.01	07/26/2018 11:53:53 AM Pacific Daylight Time	08/01/2018 05:02:21 PM Pacific Daylight Time	07/31/2018 03:18:01 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore COPD (HMO SNP)	01	01		1			H2593	005	0	2019	Pima County		2	10761	2			1	4			00000000000100000000		www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	006	0	1	01	01	H2593_006_0	9	1		1		07/26/2018	2019.01	07/26/2018 11:54:31 AM Pacific Daylight Time	08/01/2018 04:11:15 PM Pacific Daylight Time	07/31/2018 03:18:22 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore Diabetes (HMO SNP)	01	01		1			H2593	006	0	2019	Pima County		2	37945	2			1	4			00000010000000000000		www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	013	0	1	01	01	H2593_013_0	9	1		1		07/26/2018	2019.01	07/26/2018 11:55:06 AM Pacific Daylight Time	08/01/2018 04:36:08 PM Pacific Daylight Time	07/31/2018 03:18:43 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore Heart Care (HMO SNP)	01	01		1			H2593	013	0	2019	Pima County		2	11739	2			1	4			00000000000000010000		www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	018	0	1	01	01	H2593_018_0	10	1				08/01/2018	2019.01	08/01/2018 02:14:20 PM Pacific Daylight Time	08/01/2018 04:08:43 PM Pacific Daylight Time	07/31/2018 03:19:04 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore Smart Value (HMO)	01	01		1			H2593	018	0	2019	Pima County		2	30402	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	019	0	1	01	01	H2593_019_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:15:42 PM Pacific Daylight Time	08/01/2018 04:43:00 PM Pacific Daylight Time	07/31/2018 03:19:25 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore Care To You (HMO SNP)	01	01		1			H2593	019	0	2019	Maricopa County		2	9077	2			1	1	3				www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	020	0	1	01	01	H2593_020_0	11	1				08/01/2018	2019.01	08/01/2018 02:33:25 PM Pacific Daylight Time	08/01/2018 03:48:44 PM Pacific Daylight Time	07/31/2018 03:19:48 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage CareMore Care Access (HMO)	01	01		1			H2593	020	0	2019	Pima County		2	4261	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	021	0	1	01	01	H2593_021_0	8	1	2	1		08/03/2018	2019.01	08/03/2018 02:39:49 PM Eastern Daylight Time	08/05/2018 11:35:48 PM Eastern Daylight Time	08/01/2018 06:15:35 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerigroup	//arizona.caremore.com/	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H2593	021	0	2019	Select Counties in Tennessee		2	132420	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	022	0	1	01	01	H2593_022_0	9	1				08/03/2018	2019.01	08/03/2018 10:27:36 AM Eastern Daylight Time	08/05/2018 11:36:49 PM Eastern Daylight Time	08/01/2018 07:53:44 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerigroup	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	022	0	2019	Select Counties in Tennessee		2	40248	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	023	0	1	01	01	H2593_023_0	9	1				08/03/2018	2019.01	08/03/2018 10:29:59 AM Eastern Daylight Time	08/05/2018 11:37:50 PM Eastern Daylight Time	08/01/2018 07:54:29 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerigroup	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	023	0	2019	Select Counties in Tennessee		2	11916	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	024	0	1	01	01	H2593_024_0	9	1				08/03/2018	2019.01	08/03/2018 10:30:26 AM Eastern Daylight Time	08/05/2018 11:38:50 PM Eastern Daylight Time	08/01/2018 07:55:14 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerigroup	//arizona.caremore.com/	Amerivantage Plus (HMO)	01	01		1			H2593	024	0	2019	Select Counties in Tennessee		2	5964	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7f;7h1;7h2;	
H2593	025	0	1	01	01	H2593_025_0	9	1				08/03/2018	2019.01	08/03/2018 10:31:36 AM Eastern Daylight Time	08/05/2018 11:39:51 PM Eastern Daylight Time	08/01/2018 07:55:58 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerigroup	//arizona.caremore.com/	Amerivantage Balance (HMO)	01	01		1			H2593	025	0	2019	Select Counties in Tennessee		2	9180	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	026	0	1	01	01	H2593_026_0	11	1				08/03/2018	2019.01	08/03/2018 01:48:07 PM Pacific Daylight Time	08/05/2018 08:40:50 PM Pacific Daylight Time	08/01/2018 03:17:26 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Select (HMO)	01	01		1			H2593	026	0	2019	San Antonio Area		2	28144	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	027	0	1	01	01	H2593_027_0	11	1				08/03/2018	2019.01	08/03/2018 01:48:56 PM Pacific Daylight Time	08/05/2018 08:41:50 PM Pacific Daylight Time	08/01/2018 03:19:04 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Select (HMO)	01	01		1			H2593	027	0	2019	El Paso Area		2	13429	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	028	1	1	01	01	H2593_028_1	6	1				08/03/2018	2019.01	08/03/2018 01:50:04 PM Pacific Daylight Time	08/05/2018 08:42:51 PM Pacific Daylight Time	08/01/2018 03:20:40 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	028	1	2019	Select Counties in Texas	Houston Metro	2	39291	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	028	2	1	01	01	H2593_028_2	6	1				08/03/2018	2019.01	08/03/2018 02:04:48 PM Pacific Daylight Time	08/05/2018 08:43:51 PM Pacific Daylight Time	08/01/2018 03:22:00 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	028	2	2019	Select Counties in Texas	Dallas-Fort Worth Area	2	32044	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	028	3	1	01	01	H2593_028_3	6	1				08/03/2018	2019.01	08/03/2018 02:25:42 PM Pacific Daylight Time	08/05/2018 08:44:51 PM Pacific Daylight Time	08/01/2018 03:23:27 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	028	3	2019	Select Counties in Texas	Houston Metro Area	2	9832	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	028	4	1	01	01	H2593_028_4	7	1				08/03/2018	2019.01	08/03/2018 02:27:27 PM Pacific Daylight Time	08/05/2018 08:45:52 PM Pacific Daylight Time	08/01/2018 03:25:13 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	028	4	2019	Select Counties in Texas	El Paso Area	2	11276	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	028	5	1	01	01	H2593_028_5	7	1				08/03/2018	2019.01	08/03/2018 02:29:34 PM Pacific Daylight Time	08/05/2018 08:46:53 PM Pacific Daylight Time	08/01/2018 03:27:08 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	028	5	2019	Select Counties in Texas	Lubbock Area	2	37675	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	028	6	1	01	01	H2593_028_6	7	1				08/03/2018	2019.01	08/03/2018 02:30:46 PM Pacific Daylight Time	08/05/2018 08:47:53 PM Pacific Daylight Time	08/01/2018 03:28:55 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Classic (HMO)	01	01		1			H2593	028	6	2019	Select Counties in Texas	Austin Area	2	13673	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	029	0	1	01	01	H2593_029_0	11	1				08/03/2018	2019.01	08/03/2018 02:32:09 PM Pacific Daylight Time	08/05/2018 08:48:54 PM Pacific Daylight Time	08/01/2018 03:30:27 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Select (HMO)	01	01		1			H2593	029	0	2019	Houston Metro		2	65532	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	030	1	1	01	01	H2593_030_1	8	1	2	1		08/03/2018	2019.01	08/03/2018 02:41:39 PM Pacific Daylight Time	08/05/2018 08:49:55 PM Pacific Daylight Time	08/01/2018 03:31:53 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H2593	030	1	2019	Select Counties in Texas	Houston Metro Area	2	61586	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	030	2	1	01	01	H2593_030_2	8	1	2	1		08/03/2018	2019.01	08/03/2018 02:48:41 PM Pacific Daylight Time	08/05/2018 08:50:56 PM Pacific Daylight Time	08/01/2018 03:33:13 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H2593	030	2	2019	Select Counties in Texas	Dallas Area	2	34880	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	030	3	1	01	01	H2593_030_3	8	1	2	1		08/03/2018	2019.01	08/03/2018 03:08:22 PM Pacific Daylight Time	08/05/2018 08:51:57 PM Pacific Daylight Time	08/01/2018 03:35:02 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H2593	030	3	2019	Select Counties in Texas	San Antonio Area	2	47611	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	030	4	1	01	01	H2593_030_4	8	1	2	1		08/03/2018	2019.01	08/03/2018 03:12:55 PM Pacific Daylight Time	08/05/2018 08:52:58 PM Pacific Daylight Time	08/01/2018 03:36:40 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H2593	030	4	2019	Select Counties in Texas	El Paso Area	2	39104	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	030	5	1	01	01	H2593_030_5	8	1	2	1		08/03/2018	2019.01	08/03/2018 03:19:38 PM Pacific Daylight Time	08/05/2018 08:54:01 PM Pacific Daylight Time	08/01/2018 03:38:22 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H2593	030	5	2019	Select Counties in Texas	Lubbock Area	2	25689	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	030	6	1	01	01	H2593_030_6	8	1	2	1		08/03/2018	2019.01	08/03/2018 03:22:16 PM Pacific Daylight Time	08/05/2018 08:55:02 PM Pacific Daylight Time	08/01/2018 03:39:58 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H2593	030	6	2019	Select Counties in Texas	Austin Area	2	18057	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	031	0	1	02	01	H2593_031_0	9	1		1		08/03/2018	2019.01	08/03/2018 03:23:56 PM Pacific Daylight Time		08/01/2018 04:56:54 PM Pacific Daylight Time		08/05/2018 08:55:36 PM Pacific Daylight Time	08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage ESRD (HMO-POS SNP)	01	02		1			H2593	031	0	2019	Select Counties in Texas		2	5535	2			1	4			00000000100000000000		www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	032	0	1	01	01	H2593_032_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 03:26:09 PM Pacific Daylight Time	08/05/2018 08:56:38 PM Pacific Daylight Time	08/01/2018 03:41:47 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Premier (HMO SNP)	01	01		1			H2593	032	0	2019	Houston Area		2	90272	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	033	0	1	01	01	H2593_033_0	12	1	2	1		08/06/2018	2019.01	08/06/2018 11:15:45 AM Pacific Daylight Time	08/05/2018 08:57:39 PM Pacific Daylight Time	08/01/2018 03:43:24 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Secure (HMO SNP)	01	01		1			H2593	033	0	2019	Dallas-Fort Worth		2	7063	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	034	0	1	01	01	H2593_034_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 03:28:11 PM Pacific Daylight Time	08/05/2018 08:58:41 PM Pacific Daylight Time	08/01/2018 03:45:20 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Secure (HMO SNP)	01	01		1			H2593	034	0	2019	San Antonio Area		2	6634	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	035	0	1	01	01	H2593_035_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 03:29:33 PM Pacific Daylight Time	08/05/2018 08:59:43 PM Pacific Daylight Time	08/01/2018 03:47:19 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Secure (HMO SNP)	01	01		1			H2593	035	0	2019	El Paso Area		2	5749	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	036	0	1	01	01	H2593_036_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 03:38:00 PM Pacific Daylight Time	08/05/2018 09:00:45 PM Pacific Daylight Time	08/01/2018 03:48:54 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Dual Secure (HMO SNP)	01	01		1			H2593	036	0	2019	Austin Area		2	2845	2			1	3		1		1	www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	037	0	1	01	01	H2593_037_0	10	1		1		08/06/2018	2019.01	08/06/2018 11:16:53 AM Pacific Daylight Time	08/05/2018 09:01:46 PM Pacific Daylight Time	08/01/2018 03:50:38 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Diabetes (HMO SNP)	01	01		1			H2593	037	0	2019	Harris County		2	726	2			1	4			00000010000000000000		www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	038	0	1	01	01	H2593_038_0	10	1		1		08/03/2018	2019.01	08/03/2018 03:53:27 PM Pacific Daylight Time	08/05/2018 09:02:48 PM Pacific Daylight Time	08/01/2018 03:52:25 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage Heart (HMO SNP)	01	01		1			H2593	038	0	2019	Harris County		2	303	2			1	4			00000000000000010000		www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	039	0	1	01	01	H2593_039_0	10	1		1		08/03/2018	2019.01	08/03/2018 03:55:37 PM Pacific Daylight Time	08/05/2018 09:03:49 PM Pacific Daylight Time	08/01/2018 03:54:01 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	//arizona.caremore.com/	Amerivantage COPD (HMO SNP)	01	01		1			H2593	039	0	2019	Harris County		2	303	2			1	4			00000000000100000000		www.caremore.com	www.caremore.com	//arizona.caremore.com/	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	801	0	1	01	01	H2593_801_0	2	1				05/14/2018	2019.01	05/14/2018 04:38:53 PM Pacific Daylight Time					06/01/2018 05:31:00 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	caremore.com	Amerivantage CareMore EGWP (HMO)	01	01		1			H2593	801	0	2019	Arizona		1	125	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2593	802	0	1	01	01	H2593_802_0	2	1				05/14/2018	2019.01	05/14/2018 04:39:22 PM Pacific Daylight Time					06/01/2018 05:31:00 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	caremore.com	Amerivantage CareMore EGWP MAPD (HMO)	01	01		1			H2593	802	0	2019	Arizona		1	125	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	804	0	1	01	01	H2593_804_0	2	1				04/30/2018	2019.01	04/30/2018 04:38:09 PM Pacific Daylight Time					06/01/2018 05:31:00 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	Amerivantage	caremore.com	Amerivantage CareMore EGWP MAPD (HMO)	01	01		1			H2593	804	0	2019	Arizona		1	38	2			2						www.caremore.com	www.caremore.com	//arizona.caremore.com/	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	005	0	1	01	01	H2610_005_0	7	1				08/03/2018	2019.01	08/03/2018 03:22:17 PM Central Daylight Time	08/03/2018 08:08:37 AM Central Daylight Time	08/27/2018 02:02:26 PM Central Daylight Time			08/27/2018 02:10:07 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	005	0	2019	St. Louis Metropolitan Area		2	644277	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	006	0	1	01	01	H2610_006_0	7	1				08/02/2018	2019.01	08/02/2018 03:17:53 PM Central Daylight Time	08/03/2018 08:25:31 AM Central Daylight Time	08/27/2018 02:02:27 PM Central Daylight Time			08/27/2018 02:10:07 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	006	0	2019	St. Louis Metropolitan Area		2	20423	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	011	0	1	01	01	H2610_011_0	6	1				08/02/2018	2019.01	08/02/2018 03:18:26 PM Central Daylight Time	08/03/2018 09:00:32 AM Central Daylight Time	08/03/2018 08:59:05 AM Central Daylight Time			08/03/2018 10:56:58 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	011	0	2019	Columbia Metropolitan Area		2	15650	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	015	0	1	01	01	H2610_015_0	6	1				08/02/2018	2019.01	08/02/2018 03:18:53 PM Central Daylight Time	08/03/2018 09:08:07 AM Central Daylight Time	08/03/2018 09:05:49 AM Central Daylight Time			08/03/2018 10:56:58 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	CoxHealth MedicarePlus (HMO)	01	01		1			H2610	015	0	2019	Southwest Missouri		2	135912	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	016	0	1	01	01	H2610_016_0	8	1				08/02/2018	2019.01	08/02/2018 03:19:17 PM Central Daylight Time	08/03/2018 09:16:49 AM Central Daylight Time	08/27/2018 02:02:25 PM Central Daylight Time			08/27/2018 02:10:07 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Select (HMO)	01	01		1			H2610	016	0	2019	St. Louis Metropolitan area		2	22112	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	803	0	1	01	01	H2610_803_0	2	1				05/25/2018	2019.01	05/25/2018 09:50:30 AM Central Daylight Time					06/01/2018 09:46:50 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD calendar (HMO)	01	01		1			H2610	803	0	2019	MO and IL Service Area		1	600	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;	1					1				
H2610	804	0	1	01	01	H2610_804_0	2	1				05/24/2018	2019.01	05/24/2018 01:30:40 PM Central Daylight Time					06/01/2018 09:46:50 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-calendar (HMO)	01	01		1			H2610	804	0	2019	MO and IL Service Area		1	600	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;	1					1				
H2663	002	0	1	01	01	H2663_002_0	2	1				08/03/2018	2019.01	08/03/2018 04:11:26 PM Central Daylight Time	08/02/2018 01:27:42 PM Central Daylight Time	07/31/2018 09:39:02 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantra Option 2 (HMO)	01	01		1			H2663	002	0	2019	St. Louis MO Metro Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	005	0	1	01	01	H2663_005_0	2	1				08/03/2018	2019.01	08/03/2018 04:11:53 PM Central Daylight Time	08/02/2018 01:28:48 PM Central Daylight Time	07/31/2018 09:39:52 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Gold Advantage (HMO)	01	01		1			H2663	005	0	2019	St. Louis MO Metro Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	006	0	1	02	01	H2663_006_0	3	1				08/03/2018	2019.01	08/03/2018 07:50:32 PM Central Daylight Time	08/02/2018 01:32:10 PM Central Daylight Time	07/31/2018 09:40:44 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantra Option 1 (HMO-POS)	01	02		1			H2663	006	0	2019	St. Louis MO Metro Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	015	0	1	02	01	H2663_015_0	3	1				08/03/2018	2019.01	08/03/2018 04:14:19 PM Central Daylight Time	08/02/2018 01:33:20 PM Central Daylight Time	07/31/2018 09:41:34 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Total Care (HMO-POS)	01	02		1			H2663	015	0	2019	St. Louis MO Metro Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	016	0	1	01	01	H2663_016_0	2	1				08/01/2018	2019.01	08/01/2018 05:00:16 PM Eastern Daylight Time	08/02/2018 02:06:56 PM Eastern Daylight Time	07/31/2018 05:48:44 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Coventry Total Care (HMO)	01	01		1			H2663	016	0	2019	Boone, Winnebago IL		2	8964	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	017	0	1	01	01	H2663_017_0	2	1				08/03/2018	2019.01	08/03/2018 04:15:18 PM Central Daylight Time	08/02/2018 01:34:14 PM Central Daylight Time	07/31/2018 09:42:26 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Total Care (HMO)	01	01		1			H2663	017	0	2019	Peoria, Tazewell Illinois		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	021	0	1	01	01	H2663_021_0	3	1				08/06/2018	2019.01	08/06/2018 04:19:45 PM Central Daylight Time	08/03/2018 07:26:24 AM Central Daylight Time	07/31/2018 09:43:16 PM Central Daylight Time			08/06/2018 04:22:55 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantage (HMO)	01	01		1			H2663	021	0	2019	Southwest Missouri		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	022	0	1	01	01	H2663_022_0	3	1				05/29/2018	2019.01	05/29/2018 08:26:26 PM Central Daylight Time	07/20/2018 01:56:25 PM Central Daylight Time				07/24/2018 02:25:28 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantage (no drug) (HMO)	01	01		1			H2663	022	0	2019	Southwest Missouri		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2663	023	0	1	02	01	H2663_023_0	3	1				08/03/2018	2019.01	08/03/2018 04:19:27 PM Central Daylight Time	08/03/2018 07:27:15 AM Central Daylight Time	07/31/2018 09:44:06 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantage Plus (HMO-POS)	01	02		1			H2663	023	0	2019	Southwest Missouri		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	024	0	1	02	01	H2663_024_0	3	1				08/03/2018	2019.01	08/03/2018 04:21:54 PM Central Daylight Time	08/03/2018 07:28:08 AM Central Daylight Time	07/31/2018 09:44:58 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Total Care (HMO-POS)	01	02		1			H2663	024	0	2019	Oklahoma City area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	025	0	1	01	01	H2663_025_0	2	1				05/29/2018	2019.01	05/29/2018 08:27:09 PM Central Daylight Time	07/23/2018 10:09:37 AM Central Daylight Time				07/24/2018 02:25:28 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Select Advantage (no drug) (HMO)	01	01		1			H2663	025	0	2019	Limited counties Oklahoma, Missouri and Kansas		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2663	026	0	1	01	01	H2663_026_0	3	1				08/03/2018	2019.01	08/03/2018 04:31:42 PM Central Daylight Time	08/03/2018 07:29:04 AM Central Daylight Time	07/31/2018 09:45:48 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantra Advantage (HMO)	01	01		1			H2663	026	0	2019	Kansas City Metro Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	027	0	1	01	01	H2663_027_0	3	1				08/03/2018	2019.01	08/03/2018 04:31:02 PM Central Daylight Time	08/03/2018 07:29:59 AM Central Daylight Time	07/31/2018 09:46:38 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantra Advantage (HMO)	01	01		1			H2663	027	0	2019	Wyandotte County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	028	0	1	01	01	H2663_028_0	2	1				08/03/2018	2019.01	08/03/2018 04:31:31 PM Central Daylight Time	08/03/2018 07:31:39 AM Central Daylight Time	07/31/2018 09:47:32 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Medicare Advantage Total Care (HMO)	01	01		1			H2663	028	0	2019	Wichita Kansas Area		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	029	0	1	01	01	H2663_029_0	2	1				08/03/2018	2019.01	08/03/2018 04:32:02 PM Central Daylight Time	08/03/2018 07:32:34 AM Central Daylight Time	07/31/2018 09:48:24 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Advantra Total Care (HMO)	01	01		1			H2663	029	0	2019	NW Arkansas		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	032	0	1	01	01	H2663_032_0	2	1				08/03/2018	2019.01	08/03/2018 04:32:44 PM Central Daylight Time	08/02/2018 01:35:28 PM Central Daylight Time	07/31/2018 09:49:16 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.coventry-medicare.com	Gold Advantage Value (HMO)	01	01		1			H2663	032	0	2019	St. Louis and surrounding counties IL-MO		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	802	0	1	01	01	H2663_802_0	3	1				06/04/2018	2019.01	06/04/2018 10:52:07 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.chcmissourimedicare.com	Employer Group Calendar Rx (HMO)	01	01		1			H2663	802	0	2019	St. Louis MO Metro Area - Employer Group		1	32930	2			2						http//pharmacylocator.coventry-medicare.com	www.formulary.coventry-medicare.com	https//coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H2663	805	0	1	01	01	H2663_805_0	3	1				06/04/2018	2019.01	06/04/2018 10:52:24 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	www.chcmissourimedicare.com	Employer Group Calendar No Rx (HMO)	01	01		1			H2663	805	0	2019	St. Louis MO Metro Area - Employer Group		1	6290	2			2						http//pharmacylocator.coventry-medicare.com	http//www.formulary.coventry-medicare.com	https//coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H2663	810	0	1	01	01	H2663_810_0	3	1				06/04/2018	2019.01	06/04/2018 10:52:44 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	http://www.aetna-coventryretiree.com/	Employer Group SOI w/Rx (HMO)	01	01		1			H2663	810	0	2019	Illinois		1	81730	2			2						http://www.aetna-coventryretiree.com/	http://www.aetna-coventryretiree.com/	http://www.aetna-coventryretiree.com/	(855)223-4807		(855)223-4807		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H2663	811	0	1	01	01	H2663_811_0	3	1				06/04/2018	2019.01	06/04/2018 10:52:57 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Heartland Advantra Empoyer Group w/RX (HMO)	01	01		1			H2663	811	0	2019	SW Missouri		1	6960	2			2						providerdirectory.coventry.medicare.com	https://www.coventry-medicare.com/en/for-members/group-plans.html	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(844)741-8423		(844)741-8423		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H2663	812	0	1	01	01	H2663_812_0	3	1				06/04/2018	2019.01	06/04/2018 10:53:11 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Heartland Employer Group w/o RX (HMO)	01	01		1			H2663	812	0	2019	KS and MO		1	120	2			2						providerdirectory.coventry.medicare.com	https://www.coventry-medicare.com/en/for-members/group-plans.html	providerdirectory.coventry.medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H2663	813	0	1	01	01	H2663_813_0	3	1				06/04/2018	2019.01	06/04/2018 10:53:25 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Heartland Advantra Employer Group w/RX (HMO)	01	01		1			H2663	813	0	2019	SW Missouri		1	1290	2			2						https://www.coventry-medicare.com/en/prescription-drugs/find-pharmacy.html	https://www.coventry-medicare.com/en/for-members/group-plans.html	https://www.coventry-medicare.com/en/find-doctors-hospitals/find-provider.html	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(844)741-8423		(844)741-8423		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H2758	002	0	1	01	01	H2758_002_0	3	1				08/06/2018	2019.01	08/06/2018 10:24:23 AM Eastern Daylight Time	08/06/2018 10:40:38 AM Eastern Daylight Time	08/06/2018 10:40:41 AM Eastern Daylight Time			08/06/2018 10:43:38 AM Eastern Daylight Time	BEHEALTHY FLORIDA, INC.	Florida Blue Preferred HMO	FloridaBlue.com/medicare	BlueMedicare Preferred (HMO)	01	01		1			H2758	002	0	2019	Manatee and Sarasota counties		2		2			2						FloridaBlue.com/medicare	FloridaBlue.com/medicare	FloridaBlue.com/medicare	(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H2758	004	0	1	01	01	H2758_004_0	4	1				08/06/2018	2019.01	08/06/2018 10:25:25 AM Eastern Daylight Time	08/06/2018 10:40:43 AM Eastern Daylight Time	08/06/2018 10:40:46 AM Eastern Daylight Time			08/06/2018 10:43:38 AM Eastern Daylight Time	BEHEALTHY FLORIDA, INC.	Florida Blue Preferred HMO	FloridaBlue.com/medicare	BlueMedicare Preferred (HMO)	01	01		1			H2758	004	0	2019	Clay and Duval counties		2		2			2						FloridaBlue.com/medicare	FloridaBlue.com/medicare	FloridaBlue.com/medicare	(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H2758	006	0	1	01	01	H2758_006_0	3	1				08/06/2018	2019.01	08/06/2018 10:26:35 AM Eastern Daylight Time	08/06/2018 10:40:29 AM Eastern Daylight Time	08/06/2018 10:40:32 AM Eastern Daylight Time			08/06/2018 10:43:38 AM Eastern Daylight Time	BEHEALTHY FLORIDA, INC.	Florida Blue Preferred HMO	FloridaBlue.com/medicare	BlueMedicare Preferred (HMO)	01	01		1			H2758	006	0	2019	Pinellas County		2		2			2						FloridaBlue.com/medicare	FloridaBlue.com/medicare	FloridaBlue.com/medicare	(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H2758	008	0	1	02	01	H2758_008_0	4	1				08/06/2018	2019.01	08/06/2018 10:27:17 AM Eastern Daylight Time	08/06/2018 10:40:34 AM Eastern Daylight Time	08/06/2018 10:40:36 AM Eastern Daylight Time			08/06/2018 10:43:38 AM Eastern Daylight Time	BEHEALTHY FLORIDA, INC.	Florida Blue Preferred HMO	FloridaBlue.com/medicare	BlueMedicare Preferred POS (HMO-POS)	01	02		1			H2758	008	0	2019	Pinellas, Sarasota & Manatee counties		2		2			2						FloridaBlue.com/medicare	FloridaBlue.com/medicare	FloridaBlue.com/medicare	(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(844)783-5189		(844)783-5189		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H2773	003	0	1	01	01	H2773_003_0	7	1		1		08/06/2018	2019.01	08/06/2018 05:02:45 PM Eastern Daylight Time	08/07/2018 08:15:51 AM Eastern Daylight Time	08/07/2018 08:16:34 AM Eastern Daylight Time			08/07/2018 08:20:30 AM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Health LI - SNP (HMO SNP)	01	01		1			H2773	003	0	2019	Nassau, and Suffolk Counties		2	17394	2			1	4			00000000000000000010		www.qhpny.com	www.qhpny.com	www.qhpny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	017	0	1	01	01	H2773_017_0	5	1		1		08/06/2018	2019.01	08/06/2018 04:57:02 PM Eastern Daylight Time	08/07/2018 08:15:53 AM Eastern Daylight Time	08/07/2018 08:16:34 AM Eastern Daylight Time			08/07/2018 08:20:30 AM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Health NYC - SNP (HMO SNP)	01	01		1			H2773	017	0	2019	Queens County and Staten Island		2	2364	2			1	4			00000000000000000010		www.qhpny.com	www.qhpny.com	www.qhpny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	018	0	1	01	01	H2773_018_0	4	1	2	1		07/30/2018	2019.01	07/30/2018 08:39:56 PM Eastern Daylight Time	08/07/2018 08:15:53 AM Eastern Daylight Time	08/07/2018 08:16:34 AM Eastern Daylight Time			08/07/2018 08:20:30 AM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Value One NY - Dual (HMO SNP)	01	01		1			H2773	018	0	2019	Nassau, Queens, Staten Island and Suffolk Counties		2	632	2			1	3		2		2	www.qhpny.com	www.qhpny.com	www.qhpny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	019	0	1	01	01	H2773_019_0	5	1				08/06/2018	2019.01	08/06/2018 04:58:35 PM Eastern Daylight Time	08/07/2018 08:15:54 AM Eastern Daylight Time	08/07/2018 08:16:35 AM Eastern Daylight Time			08/07/2018 08:20:30 AM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Silver - NY (HMO)	01	01		1			H2773	019	0	2019	Nassau and Suffolk Counties		2	49168	2			2						www.qhpny.com	www.qhpny.com	www.qhpny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	020	0	1	01	01	H2773_020_0	5	1				08/06/2018	2019.01	08/06/2018 04:59:49 PM Eastern Daylight Time	08/07/2018 08:15:55 AM Eastern Daylight Time	08/07/2018 08:16:35 AM Eastern Daylight Time			08/07/2018 08:20:30 AM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Silver - NY City (HMO)	01	01		1			H2773	020	0	2019	Queens and Staten Island		2	8083	2			2						www.qhpny.com	www.qhpny.com	www.qhpny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	022	0	1	01	01	H2773_022_0	5	1				08/06/2018	2019.01	08/06/2018 05:01:22 PM Eastern Daylight Time	08/07/2018 08:15:55 AM Eastern Daylight Time	08/07/2018 08:16:36 AM Eastern Daylight Time			08/07/2018 08:20:30 AM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Premium - LI (HMO)	01	01		1			H2773	022	0	2019	Nassau and Suffolk Counties		2	361	2			2						www.qhpny.com	www.qhpny.com	www.qhpny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2775	082	0	1	04	01	H2775_082_0	4	1				08/03/2018	2019.01	08/03/2018 11:48:56 AM Eastern Daylight Time	08/06/2018 05:13:17 PM Eastern Daylight Time	08/01/2018 02:29:45 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 150A (PPO)	01	04		1			H2775	082	0	2019	Select Counties		2	63205	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	099	0	1	04	01	H2775_099_0	4	1				08/03/2018	2019.01	08/03/2018 04:14:22 PM Eastern Daylight Time	08/06/2018 06:47:44 PM Eastern Daylight Time	08/01/2018 02:30:06 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 450A (PPO)	01	04		1			H2775	099	0	2019	Select counties in New York		2	4646	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	100	0	1	04	01	H2775_100_0	4	1				08/03/2018	2019.01	08/03/2018 11:49:52 AM Eastern Daylight Time	08/06/2018 05:14:01 PM Eastern Daylight Time	08/01/2018 02:30:28 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 750B (PPO)	01	04		1			H2775	100	0	2019	Select counties in New York		2	21964	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	101	1	1	04	01	H2775_101_1	4	1				05/30/2018	2019.01	05/30/2018 08:46:11 PM Eastern Daylight Time	08/06/2018 05:14:45 PM Eastern Daylight Time	08/01/2018 02:30:50 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	01	04		1			H2775	101	1	2019	Selected Counties	select counties	2	73016	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	101	2	1	04	01	H2775_101_2	4	1				05/30/2018	2019.01	05/30/2018 08:47:48 PM Eastern Daylight Time	08/06/2018 05:15:30 PM Eastern Daylight Time	08/01/2018 02:31:11 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	01	04		1			H2775	101	2	2019	Selected Counties	select counties	2	31357	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	101	3	1	04	01	H2775_101_3	5	1				08/03/2018	2019.01	08/03/2018 12:19:03 PM Eastern Daylight Time	08/06/2018 05:16:12 PM Eastern Daylight Time	08/01/2018 02:31:32 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	01	04		1			H2775	101	3	2019	Selected Counties	select counties	2	45578	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	102	1	1	04	01	H2775_102_1	4	1				08/03/2018	2019.01	08/03/2018 11:51:04 AM Eastern Daylight Time	08/06/2018 06:49:31 PM Eastern Daylight Time	08/01/2018 02:31:54 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 150A (PPO)	01	04		1			H2775	102	1	2019	Selected Counties	select counties	2	20638	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	102	2	1	04	01	H2775_102_2	5	1				08/03/2018	2019.01	08/03/2018 12:19:48 PM Eastern Daylight Time	08/06/2018 05:16:56 PM Eastern Daylight Time	08/01/2018 02:32:15 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 150A (PPO)	01	04		1			H2775	102	2	2019	Selected Counties	select counties	2	725	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	103	1	1	04	01	H2775_103_1	4	1				05/30/2018	2019.01	05/30/2018 08:53:29 PM Eastern Daylight Time	08/06/2018 05:17:41 PM Eastern Daylight Time	08/01/2018 02:32:36 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	01	04		1			H2775	103	1	2019	Selected Counties	select counties	2	173692	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	103	2	1	04	01	H2775_103_2	6	1				08/03/2018	2019.01	08/03/2018 12:20:57 PM Eastern Daylight Time	08/06/2018 05:18:25 PM Eastern Daylight Time	08/01/2018 02:32:57 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	01	04		1			H2775	103	2	2019	Selected Counties	select counties	2	3726	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	104	1	1	04	01	H2775_104_1	3	1				05/30/2018	2019.01	05/30/2018 08:55:42 PM Eastern Daylight Time	06/02/2018 02:38:06 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage 300 (PPO)	01	04		1			H2775	104	1	2019	Selected Counties	select counties in NY	2	7123	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2775	104	2	1	04	01	H2775_104_2	4	1				07/12/2018	2019.01	07/12/2018 04:25:33 PM Eastern Daylight Time	07/13/2018 10:18:18 AM Eastern Daylight Time				07/16/2018 05:05:02 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Advantage 300 (PPO)	01	04		1			H2775	104	2	2019	Selected Counties	select counties in ME	2	1223	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2775	801	0	1	04	01	H2775_801_0	3	1				06/01/2018	2019.01	06/01/2018 02:38:30 PM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	Today's Options PPO - MA Group Plan (PPO)	01	04		1			H2775	801	0	2019	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2775	802	0	1	04	01	H2775_802_0	3	1				05/30/2018	2019.01	05/30/2018 08:26:49 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	Today's Options PPO - MAPD Group Plan (PPO)	01	04		1			H2775	802	0	2019	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2775	803	0	1	04	01	H2775_803_0	3	1				05/30/2018	2019.01	05/30/2018 09:05:00 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	Today's Options PPO - MAPD Group Plan - NCY (PPO)	01	04		1			H2775	803	0	2019	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2793	003	0	1	01	01	H2793_003_0	6	1				07/10/2018	2019.01	07/10/2018 09:34:07 AM Eastern Daylight Time	08/02/2018 12:08:45 PM Eastern Daylight Time	08/02/2018 11:54:55 AM Eastern Daylight Time			08/06/2018 11:03:49 AM Eastern Daylight Time	IMPERIAL INSURANCE COMPANY OF TEXAS, INC.	Imperial Insurance Company of Texas, Inc	www.imperialhealthplan.com	Imperial Insurance Company of Texas Traditional (HMO)	01	01		1			H2793	003	0	2019	Counties: BX, DL, EP, HR, TR, TV		2	36000	2			2						www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2793	004	0	1	01	01	H2793_004_0	7	1	2	1		08/01/2018	2019.01	08/01/2018 12:45:36 PM Eastern Daylight Time	08/02/2018 12:10:08 PM Eastern Daylight Time	08/02/2018 12:14:41 PM Eastern Daylight Time			08/06/2018 11:03:49 AM Eastern Daylight Time	IMPERIAL INSURANCE COMPANY OF TEXAS, INC.	Imperial Insurance Company of Texas, Inc	www.imperialhealthplan.com	Imperial Insurance Company of Texas Dual (HMO SNP)	01	01		1			H2793	004	0	2019	Counties: BX, DL, EP, HR, TR, TV		2	18000	2			1	3		2		2	www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2793	005	0	1	01	01	H2793_005_0	6	1		1		07/10/2018	2019.01	07/10/2018 09:41:30 AM Eastern Daylight Time	08/02/2018 12:07:19 PM Eastern Daylight Time	08/02/2018 11:45:32 AM Eastern Daylight Time			08/06/2018 11:03:49 AM Eastern Daylight Time	IMPERIAL INSURANCE COMPANY OF TEXAS, INC.	Imperial Insurance Company of Texas, Inc	www.imperialhealthplan.com	Imperial Insurance Company of Texas Value (HMO SNP)	01	01		1			H2793	005	0	2019	Counties: BX, DL, EP, HR, TR, TV		2	18000	2			1	4			00000000000000000010		www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	001	0	1	01	01	H2802_001_0	3	1				08/02/2018	2019.01	08/02/2018 01:49:24 PM Central Daylight Time	08/03/2018 11:34:13 AM Central Daylight Time	07/31/2018 06:34:46 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2802	001	0	2019	Omaha Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	007	0	1	01	01	H2802_007_0	4	1				08/02/2018	2019.01	08/02/2018 02:59:11 PM Central Daylight Time	08/03/2018 10:45:10 AM Central Daylight Time	07/31/2018 06:35:08 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Profile (HMO)	01	01		1			H2802	007	0	2019	Fort Wayne area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	008	0	1	01	01	H2802_008_0	4	1				08/02/2018	2019.01	08/02/2018 03:03:43 PM Central Daylight Time	08/03/2018 10:45:42 AM Central Daylight Time	07/31/2018 06:35:32 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	008	0	2019	South Bend area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	010	0	1	01	01	H2802_010_0	4	1				08/02/2018	2019.01	08/02/2018 03:04:16 PM Central Daylight Time	08/03/2018 10:46:19 AM Central Daylight Time	07/31/2018 06:35:54 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	010	0	2019	Indianapolis and Central Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	012	0	1	01	01	H2802_012_0	4	1				08/02/2018	2019.01	08/02/2018 03:04:33 PM Central Daylight Time	08/03/2018 10:46:56 AM Central Daylight Time	07/31/2018 06:36:18 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	012	0	2019	Evansville area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	013	0	1	01	01	H2802_013_0	4	1				07/12/2018	2019.01	07/12/2018 01:33:04 PM Central Daylight Time	08/03/2018 10:47:33 AM Central Daylight Time	07/31/2018 06:36:42 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	013	0	2019	Evansville area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	014	0	1	01	01	H2802_014_0	4	1				07/12/2018	2019.01	07/12/2018 01:33:30 PM Central Daylight Time	08/03/2018 10:48:09 AM Central Daylight Time	07/31/2018 06:37:04 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	014	0	2019	Indianapolis and Central Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	015	0	1	01	01	H2802_015_0	4	1				07/12/2018	2019.01	07/12/2018 01:34:29 PM Central Daylight Time	08/03/2018 10:48:46 AM Central Daylight Time	07/31/2018 06:37:28 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	015	0	2019	Northeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	016	0	1	01	01	H2802_016_0	4	1				08/02/2018	2019.01	08/02/2018 03:04:54 PM Central Daylight Time	08/03/2018 10:49:24 AM Central Daylight Time	07/31/2018 06:37:58 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	016	0	2019	Southeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	017	0	1	01	01	H2802_017_0	4	1				07/12/2018	2019.01	07/12/2018 01:35:45 PM Central Daylight Time	08/03/2018 10:50:00 AM Central Daylight Time	07/31/2018 06:38:22 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	017	0	2019	Southeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	018	0	1	01	01	H2802_018_0	4	1				08/02/2018	2019.01	08/02/2018 03:05:13 PM Central Daylight Time	08/03/2018 10:50:36 AM Central Daylight Time	07/31/2018 06:38:44 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	018	0	2019	Northwest Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	019	0	1	01	01	H2802_019_0	4	1				07/12/2018	2019.01	07/12/2018 01:36:29 PM Central Daylight Time	08/03/2018 10:51:13 AM Central Daylight Time	07/31/2018 06:39:06 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	019	0	2019	Northwest Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	020	0	1	01	01	H2802_020_0	4	1				08/02/2018	2019.01	08/02/2018 03:05:35 PM Central Daylight Time	08/03/2018 10:51:50 AM Central Daylight Time	07/31/2018 06:39:32 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	020	0	2019	West Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	021	0	1	01	01	H2802_021_0	4	1				07/12/2018	2019.01	07/12/2018 01:37:11 PM Central Daylight Time	08/03/2018 10:52:25 AM Central Daylight Time	07/31/2018 06:39:56 PM Central Daylight Time			08/06/2018 12:29:23 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	021	0	2019	West Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	022	0	1	01	01	H2802_022_0	3	1				08/02/2018	2019.01	08/02/2018 01:49:54 PM Central Daylight Time	08/03/2018 10:53:02 AM Central Daylight Time	07/31/2018 06:40:18 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2802	022	0	2019	Lincoln Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	024	0	1	01	01	H2802_024_0	3	1				08/02/2018	2019.01	08/02/2018 02:10:26 PM Central Daylight Time	08/03/2018 10:53:39 AM Central Daylight Time	07/31/2018 06:40:42 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Access (HMO)	01	01		1			H2802	024	0	2019	Chicago Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	025	0	1	01	01	H2802_025_0	3	1				07/12/2018	2019.01	07/12/2018 11:44:28 AM Central Daylight Time	08/03/2018 10:54:15 AM Central Daylight Time	07/31/2018 06:41:04 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	025	0	2019	Chicago Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	026	0	1	01	01	H2802_026_0	3	1				07/12/2018	2019.01	07/12/2018 11:45:11 AM Central Daylight Time	08/03/2018 10:54:52 AM Central Daylight Time	07/31/2018 06:41:28 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	026	0	2019	Chicago Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	027	0	1	02	01	H2802_027_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:54:39 PM Central Daylight Time	08/03/2018 10:55:29 AM Central Daylight Time	07/31/2018 06:41:52 PM Central Daylight Time			08/06/2018 10:43:58 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (HMO-POS SNP)	01	02		1			H2802	027	0	2019	Chicago Metro area		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	028	0	1	01	01	H2802_028_0	3	1				08/02/2018	2019.01	08/02/2018 02:30:29 PM Central Daylight Time	08/03/2018 10:56:06 AM Central Daylight Time	07/31/2018 06:42:14 PM Central Daylight Time			08/06/2018 09:40:33 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2802	028	0	2019	St. Louis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	029	0	1	01	01	H2802_029_0	4	1				08/06/2018	2019.01	08/06/2018 10:11:25 AM Central Daylight Time	08/03/2018 10:56:43 AM Central Daylight Time	07/31/2018 06:42:38 PM Central Daylight Time			08/07/2018 07:18:35 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	029	0	2019	Jefferson City and Columbia Metro Areas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	030	0	1	01	01	H2802_030_0	3	1				08/03/2018	2019.01	08/03/2018 09:30:18 AM Central Daylight Time	08/03/2018 10:57:20 AM Central Daylight Time	07/31/2018 06:43:00 PM Central Daylight Time			08/06/2018 09:44:22 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	030	0	2019	Springfield Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	031	0	1	01	01	H2802_031_0	4	1				08/06/2018	2019.01	08/06/2018 10:11:30 AM Central Daylight Time	08/03/2018 10:57:56 AM Central Daylight Time	07/31/2018 06:43:24 PM Central Daylight Time			08/07/2018 07:18:35 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	031	0	2019	Springfield Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	032	0	1	01	01	H2802_032_0	2	1				08/03/2018	2019.01	08/03/2018 09:29:58 AM Central Daylight Time	08/03/2018 10:58:32 AM Central Daylight Time	07/31/2018 06:43:46 PM Central Daylight Time			08/06/2018 09:47:59 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	032	0	2019	Kansas City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	033	0	1	01	01	H2802_033_0	3	1				08/06/2018	2019.01	08/06/2018 10:11:38 AM Central Daylight Time	08/03/2018 10:59:09 AM Central Daylight Time	07/31/2018 06:44:10 PM Central Daylight Time			08/07/2018 07:18:35 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	033	0	2019	Kansas City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	034	0	1	01	01	H2802_034_0	3	1				08/02/2018	2019.01	08/02/2018 02:35:33 PM Central Daylight Time	08/03/2018 10:59:45 AM Central Daylight Time	07/31/2018 06:44:32 PM Central Daylight Time			08/06/2018 09:50:07 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	034	0	2019	Butler, Harvey, and Sedgwick Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	035	0	1	01	01	H2802_035_0	4	1				08/06/2018	2019.01	08/06/2018 10:11:50 AM Central Daylight Time	08/03/2018 11:00:21 AM Central Daylight Time	07/31/2018 06:44:56 PM Central Daylight Time			08/07/2018 07:18:35 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	035	0	2019	Butler, Harvey, and Sedgwick Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	036	0	1	01	01	H2802_036_0	4	1				08/06/2018	2019.01	08/06/2018 10:11:58 AM Central Daylight Time	08/03/2018 11:00:58 AM Central Daylight Time	07/31/2018 06:45:18 PM Central Daylight Time			08/07/2018 07:18:35 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H2802	036	0	2019	Butler, Harvey, and Sedgwick Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	041	0	1	01	01	H2802_041_0	3	1				08/02/2018	2019.01	08/02/2018 12:48:28 PM Central Daylight Time	08/03/2018 11:01:35 AM Central Daylight Time	07/31/2018 06:45:40 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2802	041	0	2019	Select Counties in Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	042	0	1	01	01	H2802_042_0	2	1				05/29/2018	2019.01	05/29/2018 10:45:57 AM Central Daylight Time	08/03/2018 11:02:11 AM Central Daylight Time	07/31/2018 06:46:04 PM Central Daylight Time			08/06/2018 08:07:28 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	042	0	2019	Select Counties in Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	044	0	1	01	01	H2802_044_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 04:33:25 PM Central Daylight Time	08/03/2018 11:02:56 AM Central Daylight Time	07/31/2018 06:46:28 PM Central Daylight Time			08/06/2018 09:55:12 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H2802	044	0	2019	Select Counties in Alabama		2		2			1	3		2		2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	045	0	1	01	01	H2802_045_0	3	1				07/12/2018	2019.01	07/12/2018 11:46:02 AM Central Daylight Time	08/03/2018 11:03:36 AM Central Daylight Time	07/31/2018 06:46:56 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2802	045	0	2019	Boone and Winnebago counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	048	0	1	01	01	H2802_048_0	4	1				08/02/2018	2019.01	08/02/2018 02:36:17 PM Central Daylight Time	08/03/2018 11:04:13 AM Central Daylight Time	07/31/2018 06:47:18 PM Central Daylight Time			08/06/2018 09:52:18 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2802	048	0	2019	Columbia Metro Area		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	801	0	1	01	01	H2802_801_0	3	1				05/25/2018	2019.01	05/25/2018 04:09:38 PM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	801	0	2019	Select Counties in Alabama		1	204	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H2802	802	0	1	01	01	H2802_802_0	3	1				06/02/2018	2019.01	06/02/2018 02:04:25 PM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	802	0	2019	Select Counties in Alabama		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H2802	803	0	1	01	01	H2802_803_0	3	1				05/25/2018	2019.01	05/25/2018 04:10:36 PM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	803	0	2019	Select Counties in Alabama		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H2802	804	0	1	01	01	H2802_804_0	3	1				05/23/2018	2019.01	05/23/2018 08:30:53 AM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	804	0	2019	St Louis Area		1	35928	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2802	805	0	1	01	01	H2802_805_0	3	1				05/23/2018	2019.01	05/23/2018 08:40:37 AM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	805	0	2019	St Louis Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2802	806	0	1	01	01	H2802_806_0	3	1				05/23/2018	2019.01	05/23/2018 08:42:37 AM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	806	0	2019	St Louis Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2802	807	0	1	01	01	H2802_807_0	3	1				05/25/2018	2019.01	05/25/2018 04:11:27 PM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	807	0	2019	Springfield Area		1	168	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H2802	808	0	1	01	01	H2802_808_0	5	1				06/04/2018	2019.01	06/04/2018 11:31:43 AM Central Daylight Time					06/04/2018 11:32:11 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	808	0	2019	Springfield Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H2802	809	0	1	01	01	H2802_809_0	3	1				05/25/2018	2019.01	05/25/2018 04:16:58 PM Central Daylight Time					06/04/2018 10:04:53 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	809	0	2019	Springfield Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H2815	001	0	1	20	08	H2815_001_0	2	1				05/21/2018	2019.01	05/21/2018 09:15:28 AM Mountain Daylight Time		05/21/2018 08:12:06 AM Mountain Daylight Time			05/21/2018 09:19:14 AM Mountain Daylight Time	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	001	0	2019	Senior CommUnity Care of Colorado		2		2			2						www.voa.org	www.voa.org										(866)961-1451		(970)835-2900		(866)961-1451		(970)835-2900												(970)252-0522				(970)252-0522																
H2815	002	0	1	20	08	H2815_002_0	2	1				05/21/2018	2019.01	05/21/2018 09:16:38 AM Mountain Daylight Time		05/21/2018 08:11:36 AM Mountain Daylight Time			05/21/2018 09:19:14 AM Mountain Daylight Time	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	002	0	2019	Senior CommUnity Care of Colorado		2		2			2						www.voa.org	www.voa.org										(866)961-1451		(970)252-0522		(866)961-1451		(970)252-0522												(970)252-0522				(970)252-0522																
H2816	013	0	1	09	04	H2816_013_0	4	1				08/03/2018	2019.01	08/03/2018 11:51:47 AM Eastern Daylight Time	08/06/2018 05:20:38 PM Eastern Daylight Time	08/01/2018 02:33:17 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier Plus 250A (PFFS)	04	09	1	1			H2816	013	0	2019	Select counties		2	18316	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	019	0	1	09	04	H2816_019_0	4	1				08/03/2018	2019.01	08/03/2018 11:52:45 AM Eastern Daylight Time	08/06/2018 05:21:23 PM Eastern Daylight Time	08/01/2018 02:33:38 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier Plus 650B (PFFS)	04	09	1	1			H2816	019	0	2019	Select counties		2	22624	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	033	3	1	09	04	H2816_033_3	3	1				05/30/2018	2019.01	05/30/2018 09:02:12 PM Eastern Daylight Time	06/02/2018 08:31:54 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	033	3	2019	Selected Counties	select counties in NY	2	18823	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	033	4	1	09	04	H2816_033_4	3	1				06/01/2018	2019.01	06/01/2018 03:38:57 PM Eastern Daylight Time	06/02/2018 08:33:41 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	033	4	2019	Selected Counties	select counties in ME	2	963	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	034	1	1	09	04	H2816_034_1	4	1				07/13/2018	2019.01	07/13/2018 09:26:23 AM Eastern Daylight Time	06/02/2018 02:44:18 AM Eastern Daylight Time				07/16/2018 05:05:02 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	034	1	2019	Selected Counties	select counties	2	15914	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	034	2	1	09	04	H2816_034_2	3	1				05/30/2018	2019.01	05/30/2018 09:06:38 PM Eastern Daylight Time	06/02/2018 02:45:19 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	034	2	2019	Selected Counties	select counties	2	19731	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	035	1	1	09	04	H2816_035_1	3	1				05/30/2018	2019.01	05/30/2018 09:07:33 PM Eastern Daylight Time	06/02/2018 02:46:19 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 300 (PFFS)	04	09	1	1			H2816	035	1	2019	Selected Counties	select counties	2	78321	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	035	2	1	09	04	H2816_035_2	3	1				05/30/2018	2019.01	05/30/2018 09:09:42 PM Eastern Daylight Time	06/02/2018 02:47:19 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 300 (PFFS)	04	09	1	1			H2816	035	2	2019	Selected Counties	select counties in ME	2	1144	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	036	1	1	09	04	H2816_036_1	3	1				06/01/2018	2019.01	06/01/2018 03:35:40 PM Eastern Daylight Time	06/02/2018 02:48:17 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 300 (PFFS)	04	09	1	1			H2816	036	1	2019	Selected Counties	select counties	2	25299	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	036	2	1	09	04	H2816_036_2	3	1				06/01/2018	2019.01	06/01/2018 03:37:07 PM Eastern Daylight Time	06/02/2018 02:49:14 AM Eastern Daylight Time				06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Premier 300 (PFFS)	04	09	1	1			H2816	036	2	2019	Selected Counties	select counties	2	20784	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	801	0	1	09	04	H2816_801_0	3	1				05/30/2018	2019.01	05/30/2018 09:19:49 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	Today's Options PFFS - MA Group Plan (PFFS)	04	09	1	1			H2816	801	0	2019	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										1					1					1				
H2816	802	0	1	09	04	H2816_802_0	3	1				05/30/2018	2019.01	05/30/2018 09:41:01 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	Today's Options PFFS - MAPD Group Plan (PFFS)	04	09	1	1			H2816	802	0	2019	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1				
H2816	803	0	1	09	04	H2816_803_0	3	1				05/30/2018	2019.01	05/30/2018 09:58:06 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American, A WellCare Company	www.wellcare.com/medicare	Today's Options PFFS - MAPD Group Plan - NCY (PFFS)	04	09	1	1			H2816	803	0	2019	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1				
H2829	001	0	1	01	01	H2829_001_0	4	1				08/02/2018	2019.01	08/02/2018 07:59:49 AM Eastern Daylight Time	08/02/2018 12:03:22 PM Eastern Daylight Time	07/31/2018 05:48:22 PM Eastern Daylight Time			08/04/2018 09:29:10 PM Eastern Daylight Time	INNOVATION HEALTH PLAN, INC.	Innovation Health Medicare	www.innovationhealthmedicare.com	Innovation Health Medicare Connection Plan (HMO)	01	01		1			H2829	001	0	2019	Fairfax County and Surrounding Area		2		2			2						www.innovationhealthmedicare.com/findpharmacy	www.innovationhealthmedicare.com/formulary	www.innovationhealthmedicare.com/findprovider	(855)249-1282		(855)249-1282		(855)605-5295		(855)605-5295		(855)249-1282		(855)249-1282		(855)605-5295		(855)605-5295		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;7a;7d;7g;	
H2835	001	0	1	20	08	H2835_001_0	1	1				05/25/2018	2019.01	05/25/2018 03:57:11 PM Eastern Daylight Time		05/25/2018 03:47:04 PM Eastern Daylight Time			05/25/2018 03:59:00 PM Eastern Daylight Time	THE CASCADE PACE, INC.	Thome PACE	www.thomepace.org	Thome PACE (PACE)	08	20		1			H2835	001	0	2019	Jackson, Lenawee, and Hillsdale Counties		2		2			2						www.genoa-qol.com	www.thomepace.org	www.thomepace.org									(844)855-7223		(517)768-9791		(844)855-7223		(517)768-9791										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H2835	002	0	1	20	08	H2835_002_0	1	1				05/25/2018	2019.01	05/25/2018 03:57:39 PM Eastern Daylight Time		05/25/2018 03:46:50 PM Eastern Daylight Time			05/25/2018 03:59:00 PM Eastern Daylight Time	THE CASCADE PACE, INC.	Thome PACE	www.thomepace.org	Thome PACE Medicare Only (PACE)	08	20		1			H2835	002	0	2019	Jackson, Lenawee, and Hillsdale County		2		2			2						www.genoa-qol.com	www.thomepace.org	www.thomepace.org									(844)855-7223		(517)768-9791		(844)855-7223		(517)768-9791										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H2836	801	0	1	04	01	H2836_801_0	2	1				06/19/2018	2019.01	06/19/2018 12:54:19 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Preferred (PPO)	01	04		1			H2836	801	0	2019	Connecticut		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H2879	001	0	1	01	01	H2879_001_0	4	1	2	1		07/12/2018	2019.01	07/12/2018 01:37:04 PM Pacific Daylight Time	08/04/2018 10:12:06 AM Pacific Daylight Time	08/04/2018 11:14:04 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN	Molina Healthcare of Wisconsin	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H2879	001	0	2019	Milwaukee		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(855)315-5663		(855)315-5663		(866)403-8293		(866)403-8293		(855)315-5663		(855)315-5663		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2906	005	0	1	04	01	H2906_005_0	4	1				07/17/2018	2019.01	07/17/2018 08:22:01 AM Pacific Daylight Time	08/07/2018 05:53:52 PM Pacific Daylight Time	08/07/2018 05:54:03 PM Pacific Daylight Time			08/07/2018 06:03:04 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Select Plan (PPO)	01	04		1			H2906	005	0	2019	Churchill, Douglas, Lyon, Storey - NV		2	1752	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;	
H2906	006	0	1	04	01	H2906_006_0	6	1				08/13/2018	2019.01	08/13/2018 11:20:08 AM Pacific Daylight Time	08/07/2018 05:53:52 PM Pacific Daylight Time	08/07/2018 05:54:03 PM Pacific Daylight Time			08/13/2018 11:21:31 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Enhanced Plan (PPO)	01	04		1			H2906	006	0	2019	Churchill, Douglas, Lyon, Storey - NV		2	9600	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;	
H2906	007	0	1	04	01	H2906_007_0	7	1				08/13/2018	2019.01	08/13/2018 11:24:03 AM Pacific Daylight Time	08/07/2018 05:53:52 PM Pacific Daylight Time	08/07/2018 05:54:03 PM Pacific Daylight Time			08/13/2018 11:24:24 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Plan (PPO)	01	04		1			H2906	007	0	2019	Churchill, Douglas, Lyon, Storey - NV		2	28584	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;	
H2906	008	0	1	04	01	H2906_008_0	3	1				07/17/2018	2019.01	07/17/2018 08:23:28 AM Pacific Daylight Time	06/02/2018 06:36:00 PM Pacific Daylight Time				07/17/2018 08:33:13 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Basic Plan (PPO)	01	04		1			H2906	008	0	2019	Churchill, Douglas, Lyon, Storey - NV		2	2472	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112										(711)-		(711)-		(711)-		(711)-										2					2						1	01	4b;	
H2906	801	0	1	04	01	H2906_801_0	1	1				05/22/2018	2019.01	05/22/2018 09:06:55 AM Pacific Daylight Time					06/02/2018 06:41:19 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Group (PPO)	01	04		1			H2906	801	0	2019	State of Nevada		1	624	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2915	001	0	1	01	01	H2915_001_0	4	1	2	1		08/03/2018	2019.01	08/03/2018 03:18:41 PM Eastern Daylight Time	08/04/2018 08:40:00 AM Eastern Daylight Time	08/04/2018 08:40:02 AM Eastern Daylight Time			08/04/2018 09:30:33 AM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H2915	001	0	2019	Southwestern Zone		2		2			1	3		1		1	allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	002	0	1	01	01	H2915_002_0	4	1	2	1		08/03/2018	2019.01	08/03/2018 03:18:57 PM Eastern Daylight Time	08/04/2018 08:40:04 AM Eastern Daylight Time	08/04/2018 08:40:04 AM Eastern Daylight Time			08/04/2018 09:30:33 AM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H2915	002	0	2019	Southeastern Zone		2		2			1	3		1		1	allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	003	0	1	01	01	H2915_003_0	5	1				08/01/2018	2019.01	08/01/2018 04:40:42 PM Eastern Daylight Time	08/04/2018 08:40:06 AM Eastern Daylight Time	08/04/2018 08:40:06 AM Eastern Daylight Time			08/04/2018 09:30:33 AM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Medicare (HMO)	01	01		1			H2915	003	0	2019	Southwestern Zone		2		2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	005	0	1	01	01	H2915_005_0	4	1				08/01/2018	2019.01	08/01/2018 04:42:31 PM Eastern Daylight Time	08/04/2018 08:40:08 AM Eastern Daylight Time	08/04/2018 08:40:10 AM Eastern Daylight Time			08/04/2018 09:30:33 AM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Medicare (HMO)	01	01		1			H2915	005	0	2019	NW PA Counties		2		2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/find-doctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	006	0	1	01	01	H2915_006_0	4	1				08/01/2018	2019.01	08/01/2018 04:43:07 PM Eastern Daylight Time	08/04/2018 08:40:12 AM Eastern Daylight Time	08/04/2018 08:40:12 AM Eastern Daylight Time			08/04/2018 09:30:33 AM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Medicare (HMO)	01	01		1			H2915	006	0	2019	SE PA Counties		2		2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	007	0	1	01	01	H2915_007_0	4	1	2	1		08/03/2018	2019.01	08/03/2018 03:19:41 PM Eastern Daylight Time	08/04/2018 08:40:14 AM Eastern Daylight Time	08/04/2018 08:40:14 AM Eastern Daylight Time			08/04/2018 09:30:33 AM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H2915	007	0	2019	SE PA Counties		2		2			1	3		1		1	allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	009	0	1	01	01	H2915_009_0	4	1	2	1		08/03/2018	2019.01	08/03/2018 03:20:10 PM Eastern Daylight Time	08/04/2018 08:40:16 AM Eastern Daylight Time	08/04/2018 08:40:44 AM Eastern Daylight Time			08/04/2018 09:30:33 AM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H2915	009	0	2019	NW PA Counties		2		2			1	3		1		1	allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/find-doctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	801	0	1	01	01	H2915_801_0	2	1				05/29/2018	2019.01	05/29/2018 04:37:24 PM Pacific Daylight Time					06/04/2018 06:31:00 PM Pacific Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	801	0	2019	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/find-doctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2915	802	0	1	01	01	H2915_802_0	2	1				05/29/2018	2019.01	05/29/2018 05:27:45 PM Pacific Daylight Time					06/04/2018 06:31:00 PM Pacific Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	802	0	2019	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/find-doctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2915	803	0	1	01	01	H2915_803_0	2	1				05/29/2018	2019.01	05/29/2018 04:37:35 PM Pacific Daylight Time					06/04/2018 06:31:00 PM Pacific Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	803	0	2019	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/find-doctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2926	001	0	1	01	01	H2926_001_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 09:50:56 AM Central Daylight Time	07/31/2018 04:33:25 PM Central Daylight Time	07/31/2018 04:37:31 PM Central Daylight Time			07/31/2018 05:02:32 PM Central Daylight Time	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	PrimeWest Health	www.primewest.org/phc	Prime Health Complete (HMO SNP)	01	01		1			H2926	001	0	2019	Northern, west central, and southwestern Minnesota		2	2410	2			1	3		1		1	https://primewest.org/drug-search	https://primewest.org/pharmacy-search	https://www.primewest.org/find-a-health-care-provider	(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1					1				
H2936	001	0	1	20	08	H2936_001_0	1	1				05/22/2018	2019.01	05/22/2018 10:57:46 AM Eastern Daylight Time		05/22/2018 08:44:35 AM Eastern Daylight Time			05/22/2018 11:14:07 AM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	LifeCircles (PACE)	08	20		1			H2936	001	0	2019	Muskegon, Ottawa, Allegan		2		2			2						www.lifecircles-pace.org	www.lifecircles-pace.org										(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686										(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686																
H2936	002	0	1	20	08	H2936_002_0	1	1				05/22/2018	2019.01	05/22/2018 10:57:49 AM Eastern Daylight Time		05/22/2018 08:44:36 AM Eastern Daylight Time			05/22/2018 11:14:07 AM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	002 - Medicare Only (PACE)	08	20		1			H2936	002	0	2019	002 - Medicare Only		2		2			2						www.lifecircles-pace.org	www.lifecircles-pace.org										(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686										(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686																
H2937	001	0	1	20	08	H2937_001_0	1	1				05/25/2018	2019.01	05/25/2018 10:02:38 AM Eastern Daylight Time		05/25/2018 09:43:42 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Westmoreland county PACE	www.seniorlifepa.com	Senior LIFE Greensburg Dual Eligible (PACE)	08	20		1			H2937	001	0	2019	Senior LIFE Westmoreland		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2937	002	0	1	20	08	H2937_002_0	1	1				05/25/2018	2019.01	05/25/2018 10:02:50 AM Eastern Daylight Time		05/25/2018 09:43:42 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Westmoreland county PACE	www.Seniorlifegreensburg.com	Senior LIFE Greensburg MC Only (PACE)	08	20		1			H2937	002	0	2019	Senior LIFE Westmoreland MC Only		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2941	001	0	1	20	08	H2941_001_0	1	1				06/01/2018	2019.01	06/01/2018 03:46:42 PM Eastern Daylight Time		06/01/2018 08:44:24 AM Eastern Daylight Time			06/01/2018 03:48:19 PM Eastern Daylight Time	SENTARA LIFE CARE CORPORATION, INC	Sentara PACE	www.sentara.com/pace	Sentara Senior Community Care Dual (PACE)	08	20		1			H2941	001	0	2019	Chesapeake, Norfolk, Portsmouth, Suffolk, VA Beach		2		2			2						www.sentara.com	www.sentara.com										(800)736-4677		(757)892-5400		(800)736-4677		(757)892-5400										(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120																
H2941	002	0	1	20	08	H2941_002_0	1	1				06/01/2018	2019.01	06/01/2018 03:47:17 PM Eastern Daylight Time		06/01/2018 08:44:25 AM Eastern Daylight Time			06/01/2018 03:48:19 PM Eastern Daylight Time	SENTARA LIFE CARE CORPORATION, INC	Sentara PACE	www.sentara.com/pace	Sentara Senior Community Care Private (PACE)	08	20		1			H2941	002	0	2019	Chesapeake, Norfolk, Portsmouth, Suffolk, VA Beach		2		2			2						www.sentara.com	www.sentara.com										(800)736-8272		(757)892-5400		(800)736-8272		(757)892-5400										(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120																
H2944	013	0	1	09	04	H2944_013_0	6	1				07/03/2018	2019.01	07/03/2018 03:05:07 PM Eastern Daylight Time	08/03/2018 06:05:41 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:35:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-013 (PFFS)	04	09	3	1			H2944	013	0	2019	Select Counties in KS, MO and OK		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	114	0	1	09	04	H2944_114_0	3	1				07/02/2018	2019.01	07/02/2018 12:59:10 PM Eastern Daylight Time	06/01/2018 02:58:26 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-114 (PFFS)	04	09	3	1			H2944	114	0	2019	Select Counties in Georgia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	124	0	1	09	04	H2944_124_0	3	1				07/03/2018	2019.01	07/03/2018 12:24:18 PM Eastern Daylight Time	06/01/2018 01:04:37 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-124 (PFFS)	04	09	3	1			H2944	124	0	2019	Select Counties in Indiana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	127	0	1	09	04	H2944_127_0	4	1				07/02/2018	2019.01	07/02/2018 12:11:23 PM Eastern Daylight Time	07/18/2018 03:04:58 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 10:32:54 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-127 (PFFS)	04	09	3	1			H2944	127	0	2019	Select Counties in Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	197	0	1	09	04	H2944_197_0	2	1				07/02/2018	2019.01	07/02/2018 02:01:16 PM Eastern Daylight Time	06/01/2018 02:30:43 PM Eastern Daylight Time				07/06/2018 02:10:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-197 (PFFS)	04	09	3	1			H2944	197	0	2019	Select Counties in KS, MO and OK		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2960	004	0	1	01	01	H2960_004_0	5	1				07/17/2018	2019.01	07/17/2018 08:25:11 AM Pacific Daylight Time	08/07/2018 05:53:52 PM Pacific Daylight Time	08/07/2018 05:54:03 PM Pacific Daylight Time			08/07/2018 05:55:13 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Enhanced Plan (HMO)	01	01		1			H2960	004	0	2019	Washoe, Carson City Counties, NV		2	61308	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;	
H2960	009	0	1	01	01	H2960_009_0	3	1				07/17/2018	2019.01	07/17/2018 08:25:27 AM Pacific Daylight Time	06/02/2018 06:36:00 PM Pacific Daylight Time				07/17/2018 08:36:34 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Basic Plan (HMO)	01	01		1			H2960	009	0	2019	Washoe, Carson City Counties, NV		2	5724	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	4b;	
H2960	012	0	1	01	01	H2960_012_0	5	1				08/07/2018	2019.01	08/07/2018 02:13:26 PM Pacific Daylight Time	08/07/2018 05:53:52 PM Pacific Daylight Time	08/07/2018 05:54:03 PM Pacific Daylight Time			08/07/2018 05:57:58 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Plan (HMO)	01	01		1			H2960	012	0	2019	Washoe, Carson City Counties, NV		2	92268	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;	
H2960	018	0	1	01	01	H2960_018_0	4	1				07/19/2018	2019.01	07/19/2018 08:47:07 AM Pacific Daylight Time	08/07/2018 05:53:52 PM Pacific Daylight Time	08/07/2018 05:54:03 PM Pacific Daylight Time			08/07/2018 05:59:17 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Select (HMO)	01	01		1			H2960	018	0	2019	Washoe, Carson City Counties, NV		2	10392	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;	
H2960	019	0	1	01	01	H2960_019_0	5	1				07/19/2018	2019.01	07/19/2018 08:55:33 AM Pacific Daylight Time	08/07/2018 05:53:52 PM Pacific Daylight Time	08/07/2018 05:54:03 PM Pacific Daylight Time			08/07/2018 06:01:10 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Complete (HMO)	01	01		1			H2960	019	0	2019	Clark and Nye Counties		2		2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;	
H2960	803	0	1	01	01	H2960_803_0	1	1				05/10/2018	2019.01	05/10/2018 10:10:40 AM Pacific Daylight Time					06/02/2018 06:45:28 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Group Plan (HMO)	01	01		1			H2960	803	0	2019	State of Nevada		1	2280	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	001	0	1	01	01	H2962_001_0	12	1				07/16/2018	2019.01	07/16/2018 10:21:40 AM Eastern Daylight Time	07/31/2018 05:41:46 PM Eastern Daylight Time	07/31/2018 05:34:57 PM Eastern Daylight Time			08/03/2018 12:29:30 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Premier (HMO)	01	01		1			H2962	001	0	2019	Hernando County		2	55847	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	002	0	1	01	01	H2962_002_0	12	1				07/16/2018	2019.01	07/16/2018 09:53:52 AM Eastern Daylight Time	07/31/2018 05:42:50 PM Eastern Daylight Time	07/31/2018 05:36:46 PM Eastern Daylight Time			08/03/2018 12:29:30 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Premier Plus (HMO)	01	01		1			H2962	002	0	2019	Citrus, Hernando and Pasco Counties		2	14548	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	003	0	1	01	01	H2962_003_0	12	1				07/16/2018	2019.01	07/16/2018 09:54:09 AM Eastern Daylight Time	07/31/2018 05:45:40 PM Eastern Daylight Time	07/31/2018 05:37:33 PM Eastern Daylight Time			08/03/2018 12:29:30 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Elite (HMO)	01	01		1			H2962	003	0	2019	Pasco and Citrus Counties		2	37544	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	011	0	1	01	01	H2962_011_0	12	1				07/16/2018	2019.01	07/16/2018 09:54:22 AM Eastern Daylight Time	07/31/2018 05:46:31 PM Eastern Daylight Time	07/31/2018 05:38:10 PM Eastern Daylight Time			08/03/2018 12:29:30 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Acclaim (HMO)	01	01		1			H2962	011	0	2019	Pinellas County, Florida		2	5866	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	012	0	1	01	01	H2962_012_0	12	1				07/16/2018	2019.01	07/16/2018 09:54:38 AM Eastern Daylight Time	07/31/2018 05:47:25 PM Eastern Daylight Time	07/31/2018 05:38:51 PM Eastern Daylight Time			08/03/2018 12:29:30 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Acclaim Plus (HMO)	01	01		1			H2962	012	0	2019	Pinellas County, Florida		2	3520	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	001	0	1	01	01	H2986_001_0	7	1				08/03/2018	2019.01	08/03/2018 01:30:45 PM Pacific Daylight Time	08/03/2018 10:27:02 AM Pacific Daylight Time	08/03/2018 10:09:14 AM Pacific Daylight Time			08/03/2018 01:41:36 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	01	01		1			H2986	001	0	2019	Santa Clara County		2	26380	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	002	0	1	01	01	H2986_002_0	7	1				08/03/2018	2019.01	08/03/2018 12:16:50 PM Pacific Daylight Time	08/03/2018 10:30:30 AM Pacific Daylight Time	08/03/2018 10:10:32 AM Pacific Daylight Time			08/03/2018 01:41:36 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	01	01		1			H2986	002	0	2019	Santa Clara County		2	4314	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	004	0	1	01	01	H2986_004_0	7	1				08/03/2018	2019.01	08/03/2018 12:17:11 PM Pacific Daylight Time	08/03/2018 10:33:16 AM Pacific Daylight Time	08/03/2018 10:15:50 AM Pacific Daylight Time			08/03/2018 01:41:36 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	01	01		1			H2986	004	0	2019	Alameda County		2	26380	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	005	0	1	01	01	H2986_005_0	7	1				08/03/2018	2019.01	08/03/2018 12:17:35 PM Pacific Daylight Time	08/03/2018 10:35:16 AM Pacific Daylight Time	08/03/2018 10:17:04 AM Pacific Daylight Time			08/03/2018 01:41:36 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	01	01		1			H2986	005	0	2019	Alameda County		2	4314	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	006	0	1	01	01	H2986_006_0	7	1				08/03/2018	2019.01	08/03/2018 12:17:55 PM Pacific Daylight Time	08/03/2018 10:37:02 AM Pacific Daylight Time	08/03/2018 10:18:16 AM Pacific Daylight Time			08/03/2018 01:41:36 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	01	01		1			H2986	006	0	2019	San Mateo County		2	26380	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	007	0	1	01	01	H2986_007_0	7	1				08/03/2018	2019.01	08/03/2018 12:18:16 PM Pacific Daylight Time	08/03/2018 10:38:56 AM Pacific Daylight Time	08/03/2018 10:19:36 AM Pacific Daylight Time			08/03/2018 01:41:36 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	01	01		1			H2986	007	0	2019	San Mateo County		2	4314	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	801	0	1	01	01	H2986_801_0	1	1				05/30/2018	2019.01	05/30/2018 11:45:45 AM Pacific Daylight Time					06/02/2018 12:41:23 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage (HMO)	01	01		1			H2986	801	0	2019	Alameda, Santa Clara, San Mateo counties		1	300	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H2992	001	0	1	20	08	H2992_001_0	1	1				05/25/2018	2019.01	05/25/2018 10:03:08 AM Eastern Daylight Time		05/25/2018 09:43:39 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifepa.com	Senior LIFE Washington Dual Eligible (PACE)	08	20		1			H2992	001	0	2019	Senior LIFE Washington Fayete Greene County		2		2			2						http://granerx.com/	None										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	002	0	1	20	08	H2992_002_0	3	1				06/04/2018	2019.01	06/04/2018 11:13:59 AM Eastern Daylight Time		06/01/2018 10:00:48 AM Eastern Daylight Time			06/04/2018 11:15:46 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifewashington.com	Senior LIFE Washington Medicare Only (PACE)	08	20		1			H2992	002	0	2019	Senior LIFE Washington Greene County Medicare Only		2		2			2						http://granerx.com/	None										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	003	0	1	20	08	H2992_003_0	1	1				05/25/2018	2019.01	05/25/2018 10:03:30 AM Eastern Daylight Time		05/25/2018 09:43:50 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifeuniontown.com	Senior LIFE Uniontown Dual Eligible (PACE)	08	20		1			H2992	003	0	2019	Senior LIFE Uniontown Fayette County Dual Eligible		2		2			2						http://granerx.com/	None										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	004	0	1	20	08	H2992_004_0	1	1				05/25/2018	2019.01	05/25/2018 10:03:41 AM Eastern Daylight Time		05/25/2018 09:43:48 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifeuniontown.com	Senior LIFE Uniontown Medicare Only (PACE)	08	20		1			H2992	004	0	2019	Senior LIFE Fayette County Medicare Only		2		2			2						http://granerx.com/	None										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3018	001	0	1	48	05	H3018_001_0	3	1				07/31/2018	2019.01	07/31/2018 04:56:53 PM Eastern Daylight Time					07/31/2018 04:58:34 PM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for FIDA Care Complete	www.centersplan.com/fida	Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)	05	48		1			H3018	001	0	2019	Ki, Qu, Brx, NY, Ri Counties		2		2			2						www.centersplan.com	www.centersplan.com	www.centersplan.com	(800)466-2745		(800)466-2745		(800)466-2745		(800)466-2745		(888)266-7460		(888)266-7460		(800)466-2745		(800)466-2745		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-																
H3054	001	0	1	01	01	H3054_001_0	5	1	1	1		07/23/2018	2019.01	07/23/2018 09:01:24 AM SA Western Standard Time	08/01/2018 10:41:10 AM SA Western Standard Time	08/01/2018 10:22:54 AM SA Western Standard Time			08/06/2018 02:52:15 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Genesis Constellation Health (HMO SNP)	01	01		1			H3054	001	0	2019	Puerto Rico		2	147238	2		1	1	3		2		1	www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H3054	003	0	1	01	01	H3054_003_0	5	1	1	1		07/23/2018	2019.01	07/23/2018 09:07:16 AM SA Western Standard Time	08/01/2018 10:40:20 AM SA Western Standard Time	08/01/2018 10:23:34 AM SA Western Standard Time			08/06/2018 02:52:15 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Genesis Prime Constellation Health (HMO SNP)	01	01		1			H3054	003	0	2019	Puerto Rico		2	222469	2		1	1	3		2		1	www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H3054	004	0	1	01	01	H3054_004_0	5	1	1	1		07/23/2018	2019.01	07/23/2018 09:11:17 AM SA Western Standard Time	08/01/2018 10:39:26 AM SA Western Standard Time	08/01/2018 10:24:14 AM SA Western Standard Time			08/06/2018 02:52:15 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Genesis @ Home Constellation Health (HMO SNP)	01	01		1			H3054	004	0	2019	Puerto Rico		2	10571	2		1	1	3		2		1	www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H3060	001	0	1	20	08	H3060_001_0	1	1				05/23/2018	2019.01	05/23/2018 09:47:50 AM Eastern Daylight Time		05/23/2018 09:31:31 AM Eastern Daylight Time			05/23/2018 09:54:06 AM Eastern Daylight Time	VIECARE BUTLER, LLC	LIFE Butler County	www.lutheranseniorlife.org	VieCare Butler, LLC dba LIFE Butler County (PACE)	08	20		1			H3060	001	0	2019	Butler County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)287-5433				(724)287-5433												(711)-				(711)-																
H3060	002	0	1	20	08	H3060_002_0	1	1				05/23/2018	2019.01	05/23/2018 09:47:39 AM Eastern Daylight Time		05/23/2018 09:31:03 AM Eastern Daylight Time			05/23/2018 09:54:06 AM Eastern Daylight Time	VIECARE BUTLER, LLC	LIFE Butler County	www.lutheranseniorlife.org	VieCare Butler, LLC dba LIFE Butler County (PACE)	08	20		1			H3060	002	0	2019	Butler County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)287-5433				(724)287-5433												(711)-				(711)-																
H3071	002	0	1	01	01	H3071_002_0	6	1				07/10/2018	2019.01	07/10/2018 01:55:52 PM Central Daylight Time	08/07/2018 11:45:44 AM Central Daylight Time	08/07/2018 11:45:48 AM Central Daylight Time			08/07/2018 11:59:57 AM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP	Community Care Alliance of Illinois, NFP	www.ccaillinois.com/medicare	Community Advantage (HMO)	01	01		1			H3071	002	0	2019	Rockford Area, Chicago Area		2	49468	2			2						www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	(855)275-2781		(855)275-2781		(855)275-2781		(855)275-2781		(888)232-8479		(888)232-8479		(855)275-2781		(855)275-2781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3071	003	0	1	02	01	H3071_003_0	6	1				08/06/2018	2019.01	08/06/2018 02:34:18 PM Central Daylight Time	08/07/2018 11:45:33 AM Central Daylight Time	08/07/2018 11:45:40 AM Central Daylight Time			08/07/2018 11:59:57 AM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP	Community Care Alliance of Illinois, NFP	www.ccaillinois.com/medicare	Community Flex-Plan (HMO-POS)	01	02		1			H3071	003	0	2019	Rockford Area, Chicago Area		2	30647	2			2						www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	(855)275-2781		(855)275-2781		(855)275-2781		(855)275-2781		(888)232-8479		(888)232-8479		(855)275-2781		(855)275-2781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	001	0	1	01	01	H3113_001_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:55:12 PM Central Daylight Time	08/03/2018 09:57:08 AM Central Daylight Time	07/31/2018 06:47:44 PM Central Daylight Time			08/06/2018 10:50:25 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3113	001	0	2019	Northern and Central New Jersey		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	005	0	1	01	01	H3113_005_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 02:07:43 PM Central Daylight Time	08/03/2018 09:57:47 AM Central Daylight Time	07/31/2018 06:48:08 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H3113	005	0	2019	Select counties in New Jersey		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)514-4911		(800)514-4911		(888)834-3721		(888)834-3721		(800)514-4911		(800)514-4911		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	008	0	1	01	01	H3113_008_0	2	1		1		05/24/2018	2019.01	05/24/2018 01:19:12 PM Central Daylight Time	08/03/2018 09:58:29 AM Central Daylight Time	07/31/2018 06:48:34 PM Central Daylight Time			08/06/2018 10:50:25 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO SNP)	01	01		1			H3113	008	0	2019	Lane County		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	009	0	1	01	01	H3113_009_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 05:42:28 PM Central Daylight Time	08/03/2018 09:59:11 AM Central Daylight Time	07/31/2018 06:48:58 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHC.com/PADual	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3113	009	0	2019	Select counties in Pennsylvania		2		2			1	3		1		1	www.UHC.com/PADual	www.UHC.com/PADual	www.UHC.com/PADual	(800)290-4009		(800)290-4009		(888)834-3721		(888)834-3721		(800)290-4009		(800)290-4009		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	010	0	1	01	01	H3113_010_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 12:48:22 PM Central Daylight Time	08/03/2018 09:59:50 AM Central Daylight Time	07/31/2018 06:49:24 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3113	010	0	2019	Select counties in Rhode Island		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	011	0	1	01	01	H3113_011_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 01:10:26 PM Central Daylight Time	08/03/2018 10:00:45 AM Central Daylight Time	07/31/2018 06:49:48 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3113	011	0	2019	Kent, New Castle, and Sussex Counties		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)262-9919		(866)262-9919		(888)834-3721		(888)834-3721		(866)262-9919		(866)262-9919		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	012	0	1	01	01	H3113_012_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 05:46:23 PM Central Daylight Time	08/03/2018 10:01:25 AM Central Daylight Time	07/31/2018 06:50:14 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHC.com/PADualOne	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H3113	012	0	2019	Select Counties in Pennsylvania		2		2			1	3		1		1	www.UHC.com/PADualOne	www.UHC.com/PADualOne	www.UHC.com/PADualOne	(800)290-4009		(800)290-4009		(888)834-3721		(888)834-3721		(800)290-4009		(800)290-4009		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3132	001	0	1	01	01	H3132_001_0	4	1		1		07/02/2018	2019.01	07/02/2018 01:59:29 PM Pacific Daylight Time	08/03/2018 11:52:04 AM Pacific Daylight Time	08/03/2018 11:52:04 AM Pacific Daylight Time			08/03/2018 11:54:43 AM Pacific Daylight Time	AHF MCO OF FLORIDA, INC.	AHF	www.php-fl.org	PHP (HMO SNP)	01	01		1			H3132	001	0	2019	Broward, Miami-Dade and Duval Counties, Florida		2		2			1	4			00000000001000000000		www.php-fl.org/provider-find	www.php-fl.org/for-members/drug-benefit/formulary	www.php-fl.org/provider-find	(888)456-4715		(888)456-4715		(888)456-4715		(888)456-4715		(866)763-9096		(866)763-9096		(888)456-4715		(888)456-4715		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	022	0	1	01	01	H3152_022_0	4	1				07/11/2018	2019.01	07/11/2018 02:42:45 PM Central Daylight Time	08/02/2018 03:46:02 PM Central Daylight Time	07/31/2018 09:50:08 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3152	022	0	2019	Counties: ATL, BUR, CAM, CPM, CUM, GLO, SLM		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	045	0	1	01	01	H3152_045_0	2	1				07/11/2018	2019.01	07/11/2018 02:42:59 PM Central Daylight Time	05/29/2018 03:28:07 PM Central Daylight Time				07/11/2018 08:22:24 PM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H3152	045	0	2019	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3152	048	0	1	01	01	H3152_048_0	5	1				07/23/2018	2019.01	07/23/2018 10:31:13 PM Central Daylight Time	08/02/2018 03:47:43 PM Central Daylight Time	07/31/2018 09:50:58 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3152	048	0	2019	Northern New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	080	0	1	01	01	H3152_080_0	3	1				08/02/2018	2019.01	08/02/2018 12:06:19 PM Eastern Daylight Time	08/02/2018 03:48:37 PM Central Daylight Time	07/31/2018 09:51:52 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare NNJ Prime Plan (HMO)	01	01		1			H3152	080	0	2019	Counties: HUN, MRS, PAS, SOM, SSX, UNN, WRN		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	082	0	1	01	01	H3152_082_0	3	1				08/02/2018	2019.01	08/02/2018 12:08:44 PM Eastern Daylight Time	08/02/2018 03:51:23 PM Central Daylight Time	07/31/2018 09:52:44 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H3152	082	0	2019	Middlesex, Monmouth and Ocean counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	084	0	1	01	01	H3152_084_0	3	1				08/02/2018	2019.01	08/02/2018 12:09:17 PM Eastern Daylight Time	08/02/2018 03:52:15 PM Central Daylight Time	07/31/2018 09:53:32 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan 1 (HMO)	01	01		1			H3152	084	0	2019	Northern New Jersey, Southern New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	085	0	1	01	01	H3152_085_0	3	1				08/02/2018	2019.01	08/02/2018 12:10:49 PM Eastern Daylight Time	08/02/2018 03:53:05 PM Central Daylight Time	07/31/2018 09:54:22 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare SNJ Prime Value Plan (HMO)	01	01		1			H3152	085	0	2019	Burlington, Camden, Gloucester and Mercer counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	088	0	1	01	01	H3152_088_0	3	1				07/11/2018	2019.01	07/11/2018 02:45:21 PM Central Daylight Time	08/02/2018 03:53:54 PM Central Daylight Time	07/31/2018 09:55:12 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Smart Choice Plan (HMO)	01	01		1			H3152	088	0	2019	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	801	0	1	01	01	H3152_801_0	2	1				06/04/2018	2019.01	06/04/2018 10:53:43 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3152	801	0	2019	New Jersey		1	177900	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3152	804	0	1	01	01	H3152_804_0	2	1				06/04/2018	2019.01	06/04/2018 10:53:55 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3152	804	0	2019	New Jersey		1	16500	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3154	004	0	1	01	01	H3154_004_0	5	1				05/30/2018	2019.01	05/30/2018 01:44:12 PM Eastern Daylight Time	08/06/2018 08:56:02 AM Eastern Daylight Time	08/06/2018 08:55:13 AM Eastern Daylight Time			08/07/2018 01:10:45 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Value w/Rx (HMO)	01	01		1			H3154	004	0	2019	Counties:  CPM, HUD, SLM, UNN, WRN		2	47779	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	013	0	1	01	01	H3154_013_0	4	1				05/30/2018	2019.01	05/30/2018 11:53:04 AM Eastern Daylight Time	07/23/2018 10:24:52 AM Eastern Daylight Time				07/23/2018 10:30:23 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Value (HMO)	01	01		1			H3154	013	0	2019	Counties:  CPM, HUD,  SLM, UNN, WRN		2	3528	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3154	022	0	1	01	01	H3154_022_0	6	1				05/30/2018	2019.01	05/30/2018 01:43:47 PM Eastern Daylight Time	08/06/2018 08:57:26 AM Eastern Daylight Time	08/06/2018 08:56:44 AM Eastern Daylight Time			08/07/2018 01:10:45 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Choice w/Rx (HMO)	01	01		1			H3154	022	0	2019	11 Counties Throughout New Jersey		2	45495	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	029	0	1	01	01	H3154_029_0	4	1				08/06/2018	2019.01	08/06/2018 02:02:09 PM Eastern Daylight Time	08/07/2018 11:11:42 AM Eastern Daylight Time	08/07/2018 11:04:13 AM Eastern Daylight Time			08/07/2018 11:27:56 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	01	01		1			H3154	029	0	2019	Ocean and Monmouth		2	65039	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	030	0	1	01	01	H3154_030_0	6	1				08/07/2018	2019.01	08/07/2018 07:39:46 AM Eastern Daylight Time	08/07/2018 11:13:44 AM Eastern Daylight Time	08/07/2018 11:13:05 AM Eastern Daylight Time			08/07/2018 11:27:56 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	01	01		1			H3154	030	0	2019	Bergen, Essex, Hudson, Mercer, Middlesex, Union		2	69838	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	031	0	1	01	01	H3154_031_0	6	1				08/07/2018	2019.01	08/07/2018 07:40:50 AM Eastern Daylight Time	08/07/2018 11:16:18 AM Eastern Daylight Time	08/07/2018 11:15:15 AM Eastern Daylight Time			08/07/2018 11:27:56 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	01	01		1			H3154	031	0	2019	Hunterdon, Somerset, Sussex, Warren		2	28643	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	032	0	1	01	01	H3154_032_0	4	1				08/07/2018	2019.01	08/07/2018 07:41:13 AM Eastern Daylight Time	08/07/2018 11:18:14 AM Eastern Daylight Time	08/07/2018 11:17:00 AM Eastern Daylight Time			08/07/2018 11:27:56 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	01	01		1			H3154	032	0	2019	Atlantic, Cumberland, Morris		2	31796	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	033	0	1	02	01	H3154_033_0	6	1				08/07/2018	2019.01	08/07/2018 07:41:30 AM Eastern Daylight Time	08/07/2018 11:20:04 AM Eastern Daylight Time	08/07/2018 11:18:56 AM Eastern Daylight Time			08/07/2018 11:27:56 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Select (HMO-POS)	01	02		1			H3154	033	0	2019	Union County		2	4500	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	801	0	1	02	01	H3154_801_0	1	1				05/09/2018	2019.01	05/09/2018 08:34:26 AM Eastern Daylight Time					05/16/2018 05:30:05 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Group (HMO-POS)	01	02		1			H3154	801	0	2019	New Jersey		1	120	2			2						https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3154	802	0	1	02	01	H3154_802_0	3	1				05/09/2018	2019.01	05/09/2018 08:34:37 AM Eastern Daylight Time					05/16/2018 05:30:05 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Grp w/Rx (HMO-POS)	01	02		1			H3154	802	0	2019	New Jersey		1	7812	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3154	811	0	1	01	01	H3154_811_0	1	1				05/09/2018	2019.01	05/09/2018 08:34:46 AM Eastern Daylight Time					05/16/2018 05:30:05 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Advantage HMO10 (HMO)	01	01		1			H3154	811	0	2019	New Jersey		1	120	2			2						https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1					1				
H3154	812	0	1	02	01	H3154_812_0	1	1				05/09/2018	2019.01	05/09/2018 08:34:54 AM Eastern Daylight Time					05/16/2018 05:30:05 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/Rx Value (HMO-POS)	01	02		1			H3154	812	0	2019	New Jersey		1	120	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3170	001	0	1	01	01	H3170_001_0	7	1				08/03/2018	2019.01	08/03/2018 08:48:17 AM Eastern Daylight Time	08/06/2018 02:37:03 PM Eastern Daylight Time	08/06/2018 02:36:57 PM Eastern Daylight Time			08/06/2018 03:02:58 PM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	http://medicare.nebraskablue.com	Blue Cross Blue Shield Nebraska MA Core (HMO)	01	01		1			H3170	001	0	2019	Omaha Lincoln Metro Area		2	14284	2			2						https://www.myprime.com/en/find-pharmacy.html	https://medicare.nebraskablue.com/MedicareAdvantage/RXCost	https://medicare.nebraskablue.com/MedicareAdvantage/FindADoc	(888)488-9850		(888)488-9850		(844)899-6060		(844)899-6060		(855)457-1349		(855)457-1349		(844)899-6060		(844)899-6060		(711)-		(711)-	1	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3170	002	0	1	02	01	H3170_002_0	7	1				06/29/2018	2019.01	06/29/2018 08:57:26 AM Eastern Daylight Time	08/06/2018 02:36:46 PM Eastern Daylight Time	08/06/2018 02:36:35 PM Eastern Daylight Time			08/06/2018 03:02:58 PM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	http://medicare.nebraskablue.com	Blue Cross Blue Shield Nebraska MA Choice (HMO-POS)	01	02		1			H3170	002	0	2019	Omaha Lincoln Metro Area		2	9133	2			2						https://www.myprime.com/en/find-pharmacy.html	https://medicare.nebraskablue.com/MedicareAdvantage/RXCost	https://medicare.nebraskablue.com/MedicareAdvantage/FindADoc	(888)488-9850		(888)488-9850		(844)899-6060		(844)899-6060		(855)457-1349		(855)457-1349		(844)899-6060		(844)899-6060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3204	001	0	1	01	01	H3204_001_0	6	1				07/09/2018	2019.01	07/09/2018 03:33:05 PM Mountain Daylight Time	08/03/2018 01:20:57 PM Mountain Daylight Time	08/03/2018 11:30:12 AM Mountain Daylight Time			08/03/2018 01:56:03 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 2 with Rx (HMO)	01	01		1			H3204	001	0	2019	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	260151	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	007	0	1	01	01	H3204_007_0	6	1				07/09/2018	2019.01	07/09/2018 03:33:32 PM Mountain Daylight Time	06/04/2018 07:07:25 AM Mountain Daylight Time	08/03/2018 11:30:12 AM Mountain Daylight Time			08/03/2018 01:56:03 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 3 with Rx (HMO)	01	01		1			H3204	007	0	2019	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	48854	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	008	0	1	01	01	H3204_008_0	5	1				07/09/2018	2019.01	07/09/2018 03:33:55 PM Mountain Daylight Time	06/04/2018 07:07:25 AM Mountain Daylight Time				07/09/2018 04:07:08 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 1 (HMO)	01	01		1			H3204	008	0	2019	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	24933	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										2					2					2	2			
H3204	012	0	1	01	01	H3204_012_0	6	1	2	1		08/03/2018	2019.01	08/03/2018 09:42:35 AM Mountain Daylight Time	08/07/2018 07:25:41 AM Mountain Daylight Time	08/03/2018 11:30:13 AM Mountain Daylight Time			08/07/2018 07:29:13 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Dual Plus (HMO SNP)	01	01		1			H3204	012	0	2019	Bernalilo, Sandoval, Torrance, Valencia		2	4425	2			1	3		1		1	www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(855)465-7737		(505)923-7675		(800)347-4766		(505)923-8458		(855)465-7737		(505)923-7675		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					1					2	2			
H3204	801	0	1	01	01	H3204_801_0	3	1				05/25/2018	2019.01	05/25/2018 10:42:47 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 with Rx (HMO)	01	01		1			H3204	801	0	2019	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	2040	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1					1				
H3204	802	0	1	01	01	H3204_802_0	3	1				05/25/2018	2019.01	05/25/2018 10:42:33 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 1 (HMO)	01	01		1			H3204	802	0	2019	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1					1				
H3204	803	0	1	01	01	H3204_803_0	3	1				05/25/2018	2019.01	05/25/2018 10:42:13 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 w/ Rx NC (HMO)	01	01		1			H3204	803	0	2019	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1					1				
H3204	808	0	1	02	01	H3204_808_0	3	1				05/25/2018	2019.01	05/25/2018 10:27:59 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 (HMO-POS)	01	02		1			H3204	808	0	2019	State of New Mexico		1	141720	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		1				
H3204	809	0	1	02	01	H3204_809_0	3	1				05/25/2018	2019.01	05/25/2018 10:58:37 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 6 (HMO-POS)	01	02		1			H3204	809	0	2019	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		1				
H3204	810	0	1	02	01	H3204_810_0	3	1				05/25/2018	2019.01	05/25/2018 11:04:18 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 NC (HMO-POS)	01	02		1			H3204	810	0	2019	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		1				
H3206	001	0	1	04	01	H3206_001_0	7	1				07/09/2018	2019.01	07/09/2018 03:34:23 PM Mountain Daylight Time	08/03/2018 01:20:58 PM Mountain Daylight Time	08/03/2018 11:30:13 AM Mountain Daylight Time			08/03/2018 01:56:03 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 2 with Rx (PPO)	01	04		1			H3206	001	0	2019	State of New Mexico		2	37592	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2						2			
H3206	003	0	1	04	01	H3206_003_0	6	1				07/09/2018	2019.01	07/09/2018 03:34:42 PM Mountain Daylight Time	06/04/2018 04:00:20 PM Mountain Daylight Time				07/09/2018 04:07:08 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 1 (PPO)	01	04		1			H3206	003	0	2019	State of New Mexico		2	2371	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										2					2						2			
H3206	801	0	1	04	01	H3206_801_0	3	1				05/29/2018	2019.01	05/29/2018 02:08:12 PM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	http://www.phs.org/Medicare	Pres MediCare PPO Emp Group Plan 2 with Rx (PPO)	01	04		1			H3206	801	0	2019	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1									
H3206	802	0	1	04	01	H3206_802_0	3	1				05/25/2018	2019.01	05/25/2018 11:23:35 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	http://www.phs.org/Medicare	Pres Medicare PPO Employer Group Plan 1 (PPO)	01	04		1			H3206	802	0	2019	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1									
H3206	803	0	1	04	01	H3206_803_0	3	1				05/25/2018	2019.01	05/25/2018 11:27:14 AM Mountain Daylight Time					06/04/2018 07:13:31 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	http://www.phs.org/Medicare	Pres MediCare PPO Empl Group Plan 2 +Rx NC (PPO)	01	04		1			H3206	803	0	2019	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1									
H3219	001	0	1	04	01	H3219_001_0	4	1				08/02/2018	2019.01	08/02/2018 09:58:23 AM Central Daylight Time	08/02/2018 02:07:43 PM Eastern Daylight Time	07/31/2018 05:49:28 PM Eastern Daylight Time			08/04/2018 09:29:10 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health | Aetna Medicare Discover Plus (PPO)	01	04		1			H3219	001	0	2019	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	002	0	1	04	01	H3219_002_0	3	1				05/25/2018	2019.01	05/25/2018 12:20:42 PM Central Daylight Time	08/02/2018 02:08:24 PM Eastern Daylight Time	07/31/2018 05:51:52 PM Eastern Daylight Time			08/04/2018 09:29:10 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health | Aetna Medicare Discover Premier (PPO)	01	04		1			H3219	002	0	2019	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	003	0	1	04	01	H3219_003_0	3	1				05/23/2018	2019.01	05/23/2018 10:54:22 AM Central Daylight Time	08/02/2018 02:09:05 PM Eastern Daylight Time	07/31/2018 05:54:08 PM Eastern Daylight Time			08/04/2018 09:29:10 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health | Aetna Medicare Discover Grand (PPO)	01	04		1			H3219	003	0	2019	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	004	0	1	04	01	H3219_004_0	3	1				05/23/2018	2019.01	05/23/2018 10:54:02 AM Central Daylight Time	08/02/2018 02:09:43 PM Eastern Daylight Time	07/31/2018 05:55:26 PM Eastern Daylight Time			08/04/2018 09:29:10 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health | Aetna Medicare Discover Elite (PPO)	01	04		1			H3219	004	0	2019	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(833)570-6671		(833)570-6671		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	801	0	1	04	01	H3219_801_0	2	1				06/04/2018	2019.01	06/04/2018 11:10:54 AM Eastern Daylight Time					06/04/2018 11:11:13 AM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health | Aetna	www.aetnamedicare.com	Allina Health Aetna Medicare (PPO) (PPO)	01	04		1			H3219	801	0	2019	Allina		1	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	https://www.allinahealthaetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a1;10a;11a;11b;11c;12;15;16b;	2		1									
H3219	802	0	1	04	01	H3219_802_0	2	1				06/04/2018	2019.01	06/04/2018 11:09:49 AM Eastern Daylight Time					06/04/2018 11:11:13 AM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health | Aetna	www.aetnamedicare.com	Allina Health Aetna Medicare w/ Rx cy (PPO) (PPO)	01	04		1			H3219	802	0	2019	Allina		1	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	https://www.allinahealthaetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3227	001	0	1	01	01	H3227_001_0	9	1	2	1		05/25/2018	2019.01	05/25/2018 05:16:16 PM Eastern Daylight Time	08/06/2018 04:18:53 PM Eastern Daylight Time	08/06/2018 04:18:53 PM Eastern Daylight Time			08/06/2018 04:22:36 PM Eastern Daylight Time	ERIENIAGARA MLTC	Kalos Health Plan	Kaloshealth.org	Kalos Health Gold Plus (HMO SNP)	01	01		1			H3227	001	0	2019	Western New York		2	11634	2			1	3		1		1	Kaloshealth.org	Kaloshealth.org	Kaloshealth.org	(800)399-1954		(716)304-1213		(800)399-1954		(716)304-1213		(800)399-1954		(716)304-1213		(800)399-1954		(716)304-1213		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					1	2			
H3237	001	0	1	48	05	H3237_001_0	1	1				06/01/2018	2019.01	06/01/2018 03:13:25 PM Eastern Daylight Time					06/03/2018 04:46:52 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/calmediconnect	Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H3237	001	0	2019	Los Angeles County		2	134315	2			2						https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	www.healthnet.com/calmediconnect	(855)464-3571		(855)464-3571		(888)788-5395		(888)788-5395		(855)464-3571		(855)464-3571		(888)788-5395		(888)788-5395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H3237	002	0	1	48	05	H3237_002_0	1	1				06/01/2018	2019.01	06/01/2018 02:29:36 PM Eastern Daylight Time					06/03/2018 04:46:52 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/calmediconnect	Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H3237	002	0	2019	San Diego County		2	18270	2			2						https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	www.healthnet.com/calmediconnect	(855)464-3572		(855)464-3572		(888)788-5805		(888)788-5805		(855)464-3572		(855)464-3572		(888)788-5805		(888)788-5805		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H3239	001	0	1	01	01	H3239_001_0	3	1	2	1		07/11/2018	2019.01	07/11/2018 04:28:10 PM Eastern Daylight Time	08/02/2018 11:44:13 AM Eastern Daylight Time	07/31/2018 11:03:12 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred (HMO SNP)	01	01		1			H3239	001	0	2019	Select Louisiana Parishes		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)338-7027		(855)338-7027		(833)570-6670		(833)570-6670		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	013	0	1	01	01	H3240_013_0	10	1	2	1		08/03/2018	2019.01	08/03/2018 09:55:26 AM Eastern Daylight Time	08/06/2018 12:04:50 AM Eastern Daylight Time	08/01/2018 06:55:41 PM Eastern Daylight Time			08/06/2018 06:10:11 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H3240	013	0	2019	Eastern and Central New Jersey		2	117680	2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(844)765-5160		(844)765-5160		(844)316-0355		(844)316-0355		(844)765-5160		(844)765-5160		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	016	0	1	01	01	H3240_016_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 09:53:42 AM Eastern Daylight Time	08/06/2018 12:05:52 AM Eastern Daylight Time	08/01/2018 06:57:30 PM Eastern Daylight Time			08/06/2018 06:10:11 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H3240	016	0	2019	Select Counties in New Jersey		2	13242	2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(844)765-5160		(844)765-5160		(844)316-0355		(844)316-0355		(844)765-5160		(844)765-5160		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	017	0	1	02	01	H3240_017_0	8	1		1		08/03/2018	2019.01	08/03/2018 04:01:23 PM Eastern Daylight Time		08/01/2018 07:57:53 PM Eastern Daylight Time		08/06/2018 12:06:25 AM Eastern Daylight Time	08/06/2018 06:10:11 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage ESRD (HMO-POS SNP)	01	02		1			H3240	017	0	2019	Select Counties in New Jersey		2	2814	2			1	4			00000000100000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(844)887-6350		(844)887-6350		(844)316-0355		(844)316-0355		(844)887-6350		(844)887-6350		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	021	0	1	01	01	H3240_021_0	8	1				08/09/2018	2019.01	08/09/2018 03:31:26 PM Eastern Daylight Time	08/09/2018 03:53:27 PM Eastern Daylight Time	08/01/2018 07:58:38 PM Eastern Daylight Time			08/09/2018 03:57:15 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage Balance (HMO)	01	01		1			H3240	021	0	2019	Select Counties in New Jersey		2	5747	2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	022	0	1	01	01	H3240_022_0	6	1				08/03/2018	2019.01	08/03/2018 02:43:51 PM Eastern Daylight Time	08/06/2018 12:08:29 AM Eastern Daylight Time	08/01/2018 07:59:24 PM Eastern Daylight Time			08/06/2018 06:10:11 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H3240	022	0	2019	Select Counties in NJ		2	8237	2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	002	0	1	01	01	H3251_002_0	9	1				07/19/2018	2019.01	07/19/2018 02:02:11 PM Mountain Daylight Time	08/06/2018 11:47:50 AM Mountain Daylight Time	08/01/2018 10:51:17 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of New Mexico	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Select (HMO)	01	01		1			H3251	002	0	2019	Greater New Mexico Area		2	94111	2			2						www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	www.getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	804	0	1	01	01	H3251_804_0	2	1				06/18/2018	2019.01	06/18/2018 01:54:11 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of New Mexico	www.getbluenm.com/mapd	Blue Cross Medicare Advantage (HMO)	01	01		1			H3251	804	0	2019	New Mexico Statewide		1	10353	2			2						www.myprime.com	www.myprime.com	www.getbluenm.com/mapd/providers	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3259	001	0	1	01	01	H3259_001_0	6	1	2	1		08/06/2018	2019.01	08/06/2018 02:04:29 PM Eastern Daylight Time	08/03/2018 01:31:42 PM Eastern Daylight Time	08/03/2018 02:15:56 PM Eastern Daylight Time			08/06/2018 02:34:43 PM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus (HMO SNP)	01	01		1			H3259	001	0	2019	Tennessee		2	223500	2			1	3		1		1	bluecareplus.bcbst.com	bluecareplus.bcbst.com	bluecareplus.bcbst.com	(800)332-5762		(800)332-5762		(888)413-9637		(888)413-9637		(800)332-5762		(800)332-5762		(888)413-9637		(888)413-9637		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	001	0	1	01	01	H3276_001_0	10	1	2	1		08/13/2018	2019.01	08/13/2018 11:58:36 AM Eastern Daylight Time	08/02/2018 04:32:34 PM Eastern Daylight Time	07/31/2018 06:07:34 PM Eastern Daylight Time			08/13/2018 12:00:04 PM Eastern Daylight Time	CONNECTICARE INSURANCE COMPANY, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Passage Dual (HMO SNP)	01	01		1			H3276	001	0	2019	State of Connecticut		2	17349	2			1	3		1		2	www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-4412		(877)224-4412		(800)224-2273		(800)224-2273		(877)224-4412		(877)224-4412		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	2			
H3291	001	0	1	01	01	H3291_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:18:11 AM Eastern Daylight Time	08/07/2018 02:52:02 PM Eastern Daylight Time	08/07/2018 02:52:02 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	PRUITTHEALTH PREMIER, INC.	PruittHealth Premier (HMO SNP)	www.pruitthealthpremier.com	PruittHealth Premier (HMO SNP)	01	01		1			H3291	001	0	2019	Georgia (partial)		2	17860	2			1	1	1				www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3291	002	0	1	01	01	H3291_002_0	3	1	2	1		08/03/2018	2019.01	08/03/2018 09:24:23 AM Eastern Daylight Time	08/07/2018 02:52:02 PM Eastern Daylight Time	08/07/2018 02:52:02 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	PRUITTHEALTH PREMIER, INC.	PruittHealth Premier (HMO SNP)	www.pruitthealthpremier.com	PruittHealth Premier D-SNP (HMO SNP)	01	01		1			H3291	002	0	2019	GA (Clarke County)		2	600	2			1	3		2		1	www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3293	001	0	1	01	01	H3293_001_0	4	1				06/03/2018	2019.01	06/03/2018 04:13:00 PM Eastern Daylight Time	08/01/2018 04:06:45 PM Eastern Daylight Time	08/01/2018 08:50:37 AM Eastern Daylight Time			08/06/2018 01:32:39 PM Eastern Daylight Time	HEALTH ADVANTAGE FLORIDA, INC.	HEALTH ADVANTAGE FLORIDA, INC.	www.health-advantage-fl.com	MMM - ELITE DADE (HMO)	01	01		1			H3293	001	0	2019	FLORIDA		2	9019	2			2						www.health-advantage-fl.com	www.health-advantage-fl.com	www.health-advantage-fl.com			(844)212-9858				(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3293	002	0	1	01	01	H3293_002_0	4	1				06/03/2018	2019.01	06/03/2018 04:13:04 PM Eastern Daylight Time	08/01/2018 04:05:08 PM Eastern Daylight Time	08/01/2018 08:58:06 AM Eastern Daylight Time			08/06/2018 01:32:39 PM Eastern Daylight Time	HEALTH ADVANTAGE FLORIDA, INC.	HEALTH ADVANTAGE FLORIDA, INC.	www.health-advantage-fl.com	MMM - ELITE (HMO)	01	01		1			H3293	002	0	2019	FLORIDA		2	7623	2			2						www.health-advantage-fl.com	www.health-advantage-fl.com	www.health-advantage-fl.com			(844)212-9858				(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3293	003	0	1	01	01	H3293_003_0	4	1				06/03/2018	2019.01	06/03/2018 04:13:07 PM Eastern Daylight Time	08/01/2018 04:03:20 PM Eastern Daylight Time	08/01/2018 08:52:33 AM Eastern Daylight Time			08/06/2018 01:32:39 PM Eastern Daylight Time	HEALTH ADVANTAGE FLORIDA, INC.	HEALTH ADVANTAGE FLORIDA, INC.	www.health-advantage-fl.com	MMM - EXTRA (HMO)	01	01		1			H3293	003	0	2019	FLORIDA		2	1851	2			2						www.health-advantage-fl.com	www.health-advantage-fl.com	www.health-advantage-fl.com			(844)212-9858				(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3293	004	0	1	01	01	H3293_004_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 04:17:18 PM Eastern Daylight Time	08/01/2018 04:02:01 PM Eastern Daylight Time	08/01/2018 08:48:23 AM Eastern Daylight Time			08/06/2018 01:32:39 PM Eastern Daylight Time	HEALTH ADVANTAGE FLORIDA, INC.	HEALTH ADVANTAGE FLORIDA, INC.	www.health-advantage-fl.com	MMM - PLATINUM (HMO SNP)	01	01		1			H3293	004	0	2019	FLORIDA		2	26467	2			1	3		2		2	www.health-advantage-fl.com	www.health-advantage-fl.com	www.health-advantage-fl.com			(844)212-9858				(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3305	007	0	1	02	01	H3305_007_0	7	1				07/12/2018	2019.01	07/12/2018 09:51:11 AM Eastern Daylight Time	06/04/2018 01:48:40 PM Eastern Daylight Time				07/12/2018 01:12:27 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold without Part D (HMO-POS)	01	02		1			H3305	007	0	2019	Western NY (Rochester/Buffalo)		2	16793	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3305	015	0	1	02	01	H3305_015_0	7	1				08/01/2018	2019.01	08/01/2018 07:47:48 AM Eastern Daylight Time	08/03/2018 10:32:56 AM Eastern Daylight Time	08/01/2018 02:13:26 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold with Part D (HMO-POS)	01	02		1			H3305	015	0	2019	Western NY (Rochester/Buffalo)		2	158349	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	020	0	1	02	01	H3305_020_0	6	1				07/12/2018	2019.01	07/12/2018 09:36:12 AM Eastern Daylight Time	06/04/2018 01:48:41 PM Eastern Daylight Time				07/12/2018 01:12:27 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	Preferred Gold without Part D (HMO-POS)	01	02		1			H3305	020	0	2019	S. Tier NY, Capital District NY, Hudson Valley, NY		2	3915	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3305	021	0	1	02	01	H3305_021_0	7	1				07/12/2018	2019.01	07/12/2018 09:37:55 AM Eastern Daylight Time	08/01/2018 03:24:38 PM Eastern Daylight Time	08/01/2018 02:14:24 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	Preferred Gold with Part D (HMO-POS)	01	02		1			H3305	021	0	2019	S. Tier NY, Capital District NY, Hudson Valley, NY		2	43319	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	022	0	1	02	01	H3305_022_0	7	1				07/12/2018	2019.01	07/12/2018 09:39:15 AM Eastern Daylight Time	08/03/2018 04:33:02 PM Eastern Daylight Time	08/01/2018 02:15:22 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	GoldValue with Part D (HMO-POS)	01	02		1			H3305	022	0	2019	Cent. NY, Eastern NY, Hudson Valley NY, Vermont		2	54933	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	030	0	1	02	01	H3305_030_0	7	1				07/12/2018	2019.01	07/12/2018 09:39:57 AM Eastern Daylight Time	08/01/2018 03:40:38 PM Eastern Daylight Time	08/03/2018 04:29:00 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	GoldSecure with Part D (HMO-POS)	01	02		1			H3305	030	0	2019	Western NY (Rochester/Buffalo)		2	15988	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	801	0	1	02	01	H3305_801_0	2	1				04/25/2018	2019.01	04/25/2018 02:39:26 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold - Employer Group (HMO-POS)	01	02		1			H3305	801	0	2019	Employer Group West Region		1	12600	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1				
H3305	803	0	1	02	01	H3305_803_0	2	1				04/25/2018	2019.01	04/25/2018 02:46:13 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H3305	803	0	2019	Employer Group West Region		1	86940	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		2				
H3305	804	0	1	02	01	H3305_804_0	2	1				04/25/2018	2019.01	04/25/2018 02:48:11 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H3305	804	0	2019	Eastern NY, Hudson Valley NY, Vermont		1	47833	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		2				
H3307	002	0	1	01	01	H3307_002_0	2	1				05/24/2018	2019.01	05/24/2018 02:12:16 PM Central Daylight Time	08/03/2018 10:42:19 AM Central Daylight Time	07/31/2018 06:50:36 PM Central Daylight Time			08/06/2018 12:58:22 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3307	002	0	2019	New York City Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	012	0	1	01	01	H3307_012_0	2	1				08/02/2018	2019.01	08/02/2018 02:14:19 PM Central Daylight Time	08/03/2018 10:42:57 AM Central Daylight Time	07/31/2018 06:51:00 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3307	012	0	2019	Rockland, Orange, and Westchester counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	015	0	1	01	01	H3307_015_0	2	1				08/02/2018	2019.01	08/02/2018 02:15:09 PM Central Daylight Time	08/03/2018 10:43:36 AM Central Daylight Time	07/31/2018 06:51:26 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Mosaic (HMO)	01	01		1			H3307	015	0	2019	New York City Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)870-9604		(866)870-9604		(800)555-5757		(800)555-5757		(866)870-9604		(866)870-9604		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	018	0	1	01	01	H3307_018_0	1	1				05/21/2018	2019.01	05/21/2018 04:58:40 PM Central Daylight Time	06/01/2018 03:55:40 PM Central Daylight Time				06/02/2018 11:38:08 AM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H3307	018	0	2019	NYC and Rockland, Orange, and Westchester Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3307	023	0	1	01	01	H3307_023_0	2	1				05/24/2018	2019.01	05/24/2018 10:40:57 AM Central Daylight Time	08/03/2018 10:44:59 AM Central Daylight Time	07/31/2018 06:51:54 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3307	023	0	2019	Rockland, Orange, and Westchester counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	025	0	1	01	01	H3307_025_0	3	1				08/02/2018	2019.01	08/02/2018 02:16:34 PM Central Daylight Time	08/03/2018 10:45:41 AM Central Daylight Time	07/31/2018 06:52:16 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H3307	025	0	2019	Dutchess, Putnam, Sullivan and Ulster counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	802	0	1	01	01	H3307_802_0	1	1				05/25/2018	2019.01	05/25/2018 04:19:16 PM Central Daylight Time					06/02/2018 12:33:26 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	802	0	2019	New York Metropolitan Area		1	10536	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H3307	804	0	1	01	01	H3307_804_0	1	1				05/25/2018	2019.01	05/25/2018 04:20:20 PM Central Daylight Time					06/02/2018 12:33:26 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	804	0	2019	New York Metropolitan Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H3307	805	0	1	01	01	H3307_805_0	1	1				05/25/2018	2019.01	05/25/2018 04:20:38 PM Central Daylight Time					06/02/2018 12:33:26 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	805	0	2019	Select counties in New York		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H3312	002	0	1	01	01	H3312_002_0	4	1				08/02/2018	2019.01	08/02/2018 10:55:29 AM Eastern Daylight Time	08/02/2018 09:13:10 AM Central Daylight Time	07/31/2018 09:56:04 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	002	0	2019	Metro (Bronx, Brooklyn, Staten Island)		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	018	0	1	01	01	H3312_018_0	3	1				08/02/2018	2019.01	08/02/2018 10:57:35 AM Eastern Daylight Time	08/02/2018 09:14:48 AM Central Daylight Time	07/31/2018 09:56:54 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	018	0	2019	Westchester/Rockland Counties		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	048	0	1	01	01	H3312_048_0	3	1				08/02/2018	2019.01	08/02/2018 10:58:33 AM Eastern Daylight Time	08/02/2018 09:16:09 AM Central Daylight Time	07/31/2018 09:57:46 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	048	0	2019	Northern Central Upstate NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	062	0	1	01	01	H3312_062_0	3	1				07/11/2018	2019.01	07/11/2018 02:47:16 PM Central Daylight Time	08/02/2018 09:17:27 AM Central Daylight Time	07/31/2018 09:58:36 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	062	0	2019	Capital Region and Hudson Valley		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	063	0	1	01	01	H3312_063_0	3	1				08/02/2018	2019.01	08/02/2018 11:05:30 AM Eastern Daylight Time	08/02/2018 09:18:42 AM Central Daylight Time	07/31/2018 09:59:26 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	063	0	2019	Metro (NYC and Queens)		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	064	0	1	01	01	H3312_064_0	3	1				07/11/2018	2019.01	07/11/2018 02:48:18 PM Central Daylight Time	08/02/2018 09:20:51 AM Central Daylight Time	07/31/2018 10:00:18 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	064	0	2019	Long Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	065	0	1	01	01	H3312_065_0	3	1				08/02/2018	2019.01	08/02/2018 11:50:42 AM Eastern Daylight Time	08/02/2018 09:27:02 AM Central Daylight Time	07/31/2018 10:01:16 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	065	0	2019	Western NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	801	0	1	01	01	H3312_801_0	2	1				06/04/2018	2019.01	06/04/2018 10:54:10 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3312	801	0	2019	New York		1	920	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3312	804	0	1	01	01	H3312_804_0	2	1				06/04/2018	2019.01	06/04/2018 10:54:21 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3312	804	0	2019	New York		1	4730	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3321	001	0	1	20	08	H3321_001_0	1	1				06/01/2018	2019.01	06/01/2018 02:48:51 PM Eastern Daylight Time		06/04/2018 09:25:01 AM Eastern Daylight Time			06/04/2018 09:26:48 AM Eastern Daylight Time	LORETTO INDEPENDENT LIVING SERVICES, INC.	Independent Living Srvcs Of Central Ny	www.pacecny.org	PACE CNY (PACE)	08	20		1			H3321	001	0	2019	Onondaga County		2		2			2						www.loretto-cny.org	Independent Living Services of Central New York, Inc										(888)728-7223		(315)452-5800		(888)728-7223		(315)452-5800										(800)662-1220		(315)452-5800		(800)662-1220		(315)452-5800																
H3321	003	0	1	20	08	H3321_003_0	1	1				06/01/2018	2019.01	06/01/2018 02:48:46 PM Eastern Daylight Time		06/04/2018 09:25:22 AM Eastern Daylight Time			06/04/2018 09:26:48 AM Eastern Daylight Time	LORETTO INDEPENDENT LIVING SERVICES, INC.	Independent Living Srvcs Of Central Ny	www.pacecny.org	PACE CNY (PACE)	08	20		1			H3321	003	0	2019	Onondaga County		2		2			2						www.loretto-cny.org	Independent Living Services of Central New York, Inc										(888)728-7223		(315)452-5800		(888)728-7223		(315)452-5800										(800)662-1220		(315)452-5800		(800)662-1220		(315)452-5800																
H3322	001	0	1	20	08	H3322_001_0	1	1				05/31/2018	2019.01	05/31/2018 03:54:41 PM Eastern Daylight Time		05/22/2018 09:05:32 AM Eastern Daylight Time			05/31/2018 03:56:23 PM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	www.nehealth.com/Senior_Services/Senior_Care_PACE/	Senior Care Connection dba Eddy SeniorCare (PACE)	08	20		1			H3322	001	0	2019	Schenectady County, Albany County, NY		2		2			2						www.northeasthealth.com	www.northeasthealth.com										(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361															
H3322	002	0	1	20	08	H3322_002_0	1	1				05/31/2018	2019.01	05/31/2018 03:55:04 PM Eastern Daylight Time		05/22/2018 09:05:33 AM Eastern Daylight Time			05/31/2018 03:56:23 PM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	www.nehealth.com/Senior_Services/Senior_Care_PACE/	Senior Care Connection dba:  Eddy SeniorCare (PACE)	08	20		1			H3322	002	0	2019	Schenectady County, Albany County		2		2			2						www.northeasthealth.com	www.northeasthealth.com										(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361															
H3328	001	0	1	02	01	H3328_001_0	6	1				06/01/2018	2019.01	06/01/2018 09:38:22 AM Eastern Daylight Time	05/31/2018 12:15:53 PM Eastern Daylight Time				06/04/2018 10:36:17 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage without Rx (HMO-POS)	01	02		1			H3328	001	0	2019	NY Counties		2	49	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3328	002	0	1	01	01	H3328_002_0	9	1	2	1		07/27/2018	2019.01	07/27/2018 11:42:10 AM Eastern Daylight Time	08/01/2018 11:46:01 AM Eastern Daylight Time	08/01/2018 11:46:01 AM Eastern Daylight Time			08/01/2018 12:21:19 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Dual Advantage (HMO SNP)	01	01		1			H3328	002	0	2019	NY Counties		2	1333	2			1	3		1		1	www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(711)-		(711)-		(711)-		(711)-		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2	2			
H3328	003	0	1	02	01	H3328_003_0	8	1				07/09/2018	2019.01	07/09/2018 02:34:20 PM Eastern Daylight Time	08/01/2018 11:46:01 AM Eastern Daylight Time	08/01/2018 11:45:59 AM Eastern Daylight Time			08/01/2018 12:21:19 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Flex (HMO-POS)	01	02		1			H3328	003	0	2019	NY Counties		2	6776	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(711)-		(711)-		(711)-		(711)-		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2	2			
H3328	016	0	1	01	01	H3328_016_0	8	1	2	1		07/09/2018	2019.01	07/09/2018 02:37:16 PM Eastern Daylight Time	08/01/2018 11:45:59 AM Eastern Daylight Time	08/01/2018 11:46:00 AM Eastern Daylight Time			08/01/2018 12:21:19 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicaid Advantage Plus (HMO SNP)	01	01		1			H3328	016	0	2019	NY Counties		2	144	2			1	3		1		1	www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(711)-		(711)-		(711)-		(711)-		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2	2			
H3328	017	0	1	01	01	H3328_017_0	7	1	2	1		07/27/2018	2019.01	07/27/2018 10:27:24 AM Eastern Daylight Time	08/01/2018 11:46:00 AM Eastern Daylight Time	08/01/2018 11:46:00 AM Eastern Daylight Time			08/01/2018 12:21:19 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Dual Advantage Flex (HMO SNP)	01	01		1			H3328	017	0	2019	NY Counties		2	38688	2			1	3		2		2	www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(711)-		(711)-		(711)-		(711)-		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2	2			
H3328	021	0	1	01	01	H3328_021_0	6	1				06/01/2018	2019.01	06/01/2018 09:40:11 AM Eastern Daylight Time	08/01/2018 11:46:00 AM Eastern Daylight Time	08/01/2018 11:46:00 AM Eastern Daylight Time			08/01/2018 12:21:19 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare $0 Premium (HMO)	01	01		1			H3328	021	0	2019	NY Counties		2	3539	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	801	0	1	02	01	H3328_801_0	3	1				06/04/2018	2019.01	06/04/2018 10:33:20 AM Eastern Daylight Time					06/04/2018 10:36:17 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer without RX (HMO-POS)	01	02		1			H3328	801	0	2019	New York Counties		1	500	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3328	802	0	1	02	01	H3328_802_0	3	1				06/04/2018	2019.01	06/04/2018 10:33:34 AM Eastern Daylight Time					06/04/2018 10:36:17 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer (HMO-POS)	01	02		1			H3328	802	0	2019	New York Counties		1	500	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(711)-		(711)-		(711)-		(711)-		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2	2			
H3328	803	0	1	02	01	H3328_803_0	3	1				06/04/2018	2019.01	06/04/2018 10:33:50 AM Eastern Daylight Time					06/04/2018 10:36:17 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer Non-calendar (HMO-POS)	01	02		1			H3328	803	0	2019	New York Counties		1	500	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(711)-		(711)-		(711)-		(711)-		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2	2			
H3329	001	0	1	20	08	H3329_001_0	1	1				06/04/2018	2019.01	06/04/2018 03:36:51 PM Eastern Daylight Time		06/04/2018 03:45:04 PM Eastern Daylight Time			06/04/2018 03:46:16 PM Eastern Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight TeamCare	http://www.centerlighthealthcare.org/	CenterLight Healthcare PACE Dual Eligible (PACE)	08	20		1			H3329	001	0	2019	NYC  and Westchester Counties		2		2			2						N/A	N/A										(877)226-8500		(347)640-6039		(877)226-8500		(347)640-6039										(711)-		(711)-		(711)-		(711)-																
H3329	002	0	1	20	08	H3329_002_0	1	1				06/04/2018	2019.01	06/04/2018 03:37:14 PM Eastern Daylight Time		06/04/2018 03:42:49 PM Eastern Daylight Time			06/04/2018 03:46:16 PM Eastern Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight TeamCare	http://www.centerlighthealthcare.org/	CenterLight Healthcare - PACE - Medicare only (PACE)	08	20		1			H3329	002	0	2019	NYC and Westchester Counties		2		2			2						N/A	N/A										(877)226-8500		(347)640-6039		(877)226-8500		(347)640-6039										(711)-		(711)-		(711)-		(711)-																
H3330	021	1	1	01	01	H3330_021_1	10	1				08/06/2018	2019.01	08/06/2018 01:54:03 PM Eastern Daylight Time	08/02/2018 08:46:56 PM Eastern Daylight Time	07/31/2018 06:19:56 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	1	2019	NYC, Long Island and Lower Hudson Valley Counties	Brx,Kings, New York, Queens Counties	2	67797	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	2	1	01	01	H3330_021_2	10	1				07/26/2018	2019.01	07/26/2018 12:46:24 AM Eastern Daylight Time	08/02/2018 08:58:08 PM Eastern Daylight Time	07/31/2018 06:20:52 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	2	2019	NYC, Long Island and Lower Hudson Valley Counties	Nassau and Richmond Counties	2	51516	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	3	1	01	01	H3330_021_3	9	1				07/17/2018	2019.01	07/17/2018 10:20:02 AM Eastern Daylight Time	08/02/2018 08:58:50 PM Eastern Daylight Time	07/31/2018 06:21:46 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	3	2019	NYC, Long Island and Lower Hudson Valley Counties	Suffolk County	2	7543	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	4	1	01	01	H3330_021_4	9	1				08/03/2018	2019.01	08/03/2018 10:37:36 AM Eastern Daylight Time	08/03/2018 06:50:38 AM Eastern Daylight Time	07/31/2018 06:22:34 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	4	2019	NYC, Long Island and Lower Hudson Valley Counties	Lower Hudson Valley Counties	2	3394	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	1	1	01	01	H3330_032_1	9	1				08/06/2018	2019.01	08/06/2018 01:58:27 PM Eastern Daylight Time	08/03/2018 06:55:48 AM Eastern Daylight Time	07/31/2018 06:23:34 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	1	2019	NYC, Long Island and Lower Hudson Valley Counties	Brx,Kings, New York and Queens Counties	2	241202	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	2	1	01	01	H3330_032_2	11	1				08/06/2018	2019.01	08/06/2018 02:05:15 PM Eastern Daylight Time	08/03/2018 06:57:26 AM Eastern Daylight Time	07/31/2018 06:24:22 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	2	2019	NYC, Long Island and Lower Hudson Valley Counties	Nassau and Richmond Counties	2	50724	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	3	1	01	01	H3330_032_3	10	1				08/06/2018	2019.01	08/06/2018 02:05:54 PM Eastern Daylight Time	08/03/2018 06:59:14 AM Eastern Daylight Time	07/31/2018 06:25:16 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	3	2019	NYC, Long Island and Lower Hudson Valley Counties	Suffolk County	2	13351	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	4	1	01	01	H3330_032_4	10	1				08/06/2018	2019.01	08/06/2018 02:10:02 PM Eastern Daylight Time	08/03/2018 07:01:14 AM Eastern Daylight Time	07/31/2018 06:26:00 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	4	2019	NYC, Long Island and Lower Hudson Valley Counties	Lower Hudson Valley Counties	2	12434	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	036	0	1	01	01	H3330_036_0	9	1				08/06/2018	2019.01	08/06/2018 01:57:44 PM Eastern Daylight Time	08/03/2018 07:02:16 AM Eastern Daylight Time	07/31/2018 06:27:18 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Value (HMO)	01	01		1			H3330	036	0	2019	NYC, Long Island and Lower Hudson Valley Counties		2	47365	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	038	0	1	01	01	H3330_038_0	11	1				07/17/2018	2019.01	07/17/2018 12:21:14 PM Eastern Daylight Time	08/03/2018 07:02:48 AM Eastern Daylight Time	07/31/2018 06:28:02 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold Plus (HMO)	01	01		1			H3330	038	0	2019	NYC, Long Island and Lower Hudson Valley Counties		2	17195	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	039	1	1	01	01	H3330_039_1	9	1				07/09/2018	2019.01	07/09/2018 05:37:40 PM Eastern Daylight Time	08/03/2018 07:08:38 AM Eastern Daylight Time	07/31/2018 06:28:46 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Rx Saver (HMO)	01	01		1			H3330	039	1	2019	Bronx and Westchester Counties	Bronx County	2	3799	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	039	2	1	01	01	H3330_039_2	9	1				07/09/2018	2019.01	07/09/2018 05:38:07 PM Eastern Daylight Time	08/03/2018 07:09:48 AM Eastern Daylight Time	07/31/2018 06:29:22 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Rx Saver (HMO)	01	01		1			H3330	039	2	2019	Bronx and Westchester Counties	Westchester County	2	1458	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	040	0	1	01	01	H3330_040_0	10	1				08/06/2018	2019.01	08/06/2018 02:13:37 PM Eastern Daylight Time	08/03/2018 07:10:40 AM Eastern Daylight Time	07/31/2018 06:30:32 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Part B Saver (HMO)	01	01		1			H3330	040	0	2019	NYC, Long Island and Lower Hudson Valley Counties		2	8875	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	041	1	1	02	01	H3330_041_1	9	1				07/17/2018	2019.01	07/17/2018 02:26:26 PM Eastern Daylight Time	08/03/2018 07:11:18 AM Eastern Daylight Time	07/31/2018 06:31:16 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Go (HMO-POS)	01	02		1			H3330	041	1	2019	NYC, Long Island and Lower Hudson Valley Counties	NYC, Nassau, Lower Hudson Valley Counties	2	7952	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	041	2	1	02	01	H3330_041_2	9	1				07/17/2018	2019.01	07/17/2018 03:14:19 PM Eastern Daylight Time	08/03/2018 07:12:20 AM Eastern Daylight Time	07/31/2018 06:32:04 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Go (HMO-POS)	01	02		1			H3330	041	2	2019	NYC, Long Island and Lower Hudson Valley Counties	Suffolk County	2	7952	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	042	1	1	01	01	H3330_042_1	10	1	2	1		08/06/2018	2019.01	08/06/2018 02:14:53 PM Eastern Daylight Time	08/03/2018 07:13:12 AM Eastern Daylight Time	07/31/2018 06:32:42 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Dual (HMO SNP)	01	01		1			H3330	042	1	2019	NYC, Long Island and Lower Hudson Valley Counties	Bronx, Kings, New York and Queens Counties	2	111920	2			1	3		1		1	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	042	2	1	01	01	H3330_042_2	10	1	2	1		08/06/2018	2019.01	08/06/2018 01:46:23 PM Eastern Daylight Time	08/03/2018 07:13:42 AM Eastern Daylight Time	07/31/2018 06:33:52 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Dual (HMO SNP)	01	01		1			H3330	042	2	2019	NYC, Long Island and Lower Hudson Valley Counties	Suffolk County	2	12979	2			1	3		1		1	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	042	3	1	01	01	H3330_042_3	10	1	2	1		08/06/2018	2019.01	08/06/2018 01:46:44 PM Eastern Daylight Time	08/03/2018 07:14:54 AM Eastern Daylight Time	07/31/2018 06:34:28 PM Eastern Daylight Time			08/06/2018 02:41:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Dual (HMO SNP)	01	01		1			H3330	042	3	2019	NYC, Long Island and Lower Hudson Valley Counties	Richmond, Nassau and Lower Hudson Valley Counties	2	29473	2			1	3		1		1	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	814	0	1	01	01	H3330_814_0	2	1				05/07/2018	2019.01	05/07/2018 04:38:59 PM Eastern Daylight Time					05/25/2018 02:49:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Premier (HMO)	01	01		1			H3330	814	0	2019	NYC, Long Island and Lower Hudson Valley Counties		1	590400	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	815	0	1	01	01	H3330_815_0	1	1				05/07/2018	2019.01	05/07/2018 04:04:19 PM Eastern Daylight Time					05/25/2018 02:45:45 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Rx Carveout (HMO)	01	01		1			H3330	815	0	2019	NYC, Long Island and Lower Hudson Valley Counties		1	186960	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3330	818	0	1	01	01	H3330_818_0	1	1	2	1		05/07/2018	2019.01	05/07/2018 05:37:51 PM Eastern Daylight Time					05/25/2018 02:45:45 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Dual Group (HMO SNP)	01	01		1			H3330	818	0	2019	NYC, Long Island and Lower Hudson Valley Counties		1	1860	2			1	3		1		1	emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	819	0	1	01	01	H3330_819_0	1	1				05/07/2018	2019.01	05/07/2018 05:48:31 PM Eastern Daylight Time					05/25/2018 02:45:45 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Premier (HMO)	01	01		1			H3330	819	0	2019	NYC, Long Island and Lower Hudson Valley Counties		1	6000	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	820	0	1	02	01	H3330_820_0	1	1				05/07/2018	2019.01	05/07/2018 05:54:51 PM Eastern Daylight Time					05/25/2018 02:45:45 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Choice (HMO-POS)	01	02		1			H3330	820	0	2019	NYC, Long Island and Lower Hudson Valley Counties		1	6000	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3331	001	0	1	20	08	H3331_001_0	1	1				05/21/2018	2019.01	05/21/2018 09:03:20 AM Eastern Daylight Time		05/21/2018 08:22:05 AM Eastern Daylight Time			05/21/2018 09:07:29 AM Eastern Daylight Time	INDEPENDENT LIVING FOR SENIORS, INC.	ElderONE an Affiliate of Rochester Regional Health	www.ElderONE.org	ElderONE an Affiliate of Rochester Regional Health (PACE)	08	20		1			H3331	001	0	2019	Monroe, Wayne, Ontario Counties		2		2			2						www.rochestergeneral.org/hillhaven	www.rochestergeneral.org										(855)457-4636		(585)922-2831		(855)457-4636		(585)922-2831										(800)662-1220		(585)922-2831		(800)662-1220		(585)922-2831																
H3331	002	0	1	20	08	H3331_002_0	1	1				05/21/2018	2019.01	05/21/2018 09:03:51 AM Eastern Daylight Time		05/21/2018 08:20:40 AM Eastern Daylight Time			05/21/2018 09:07:29 AM Eastern Daylight Time	INDEPENDENT LIVING FOR SENIORS, INC.	ElderONE an Affiliate of Rochester Regional Health	www.ElderONE.org	ElderONE an Affiliate of Rochester Regional Health (PACE)	08	20		1			H3331	002	0	2019	Monroe, Wayne, Ontario Counties		2		2			2						www.rochestergeneral.org/hillhaven	www.rochestergeneral.org										(855)457-4636		(585)922-2831		(855)457-4636		(585)922-2831										(800)662-1220		(585)922-2831		(800)662-1220		(585)922-2831																
H3335	005	0	1	04	01	H3335_005_0	4	1				08/05/2018	2019.01	08/05/2018 09:18:15 PM Eastern Daylight Time	08/06/2018 01:52:18 PM Eastern Daylight Time	08/06/2018 01:52:19 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSecure (PPO)	01	04		1			H3335	005	0	2019	Utica-Rome Metro Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	006	0	1	04	01	H3335_006_0	4	1				08/05/2018	2019.01	08/05/2018 09:18:47 PM Eastern Daylight Time	08/06/2018 01:52:20 PM Eastern Daylight Time	08/06/2018 01:52:22 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced (PPO)	01	04		1			H3335	006	0	2019	Utica-Rome Metro Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	014	0	1	04	01	H3335_014_0	4	1				08/05/2018	2019.01	08/05/2018 09:21:03 PM Eastern Daylight Time	08/06/2018 01:52:23 PM Eastern Daylight Time	08/06/2018 01:52:24 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSecure (PPO)	01	04		1			H3335	014	0	2019	Central New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	015	0	1	04	01	H3335_015_0	4	1				08/05/2018	2019.01	08/05/2018 09:21:34 PM Eastern Daylight Time	08/06/2018 01:52:25 PM Eastern Daylight Time	08/06/2018 01:52:27 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced (PPO)	01	04		1			H3335	015	0	2019	Central New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	018	0	1	04	01	H3335_018_0	4	1				05/30/2018	2019.01	05/30/2018 02:38:13 PM Eastern Daylight Time	08/06/2018 01:52:28 PM Eastern Daylight Time	08/06/2018 01:52:29 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BluePlus (PPO)	01	04		1			H3335	018	0	2019	East New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	038	0	1	04	01	H3335_038_0	4	1				08/05/2018	2019.01	08/05/2018 09:20:21 PM Eastern Daylight Time	08/06/2018 01:52:07 PM Eastern Daylight Time	08/06/2018 01:52:09 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic (PPO)	01	04		1			H3335	038	0	2019	Central New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	041	0	1	04	01	H3335_041_0	3	1				05/30/2018	2019.01	05/30/2018 02:47:38 PM Eastern Daylight Time	06/04/2018 02:51:55 PM Eastern Daylight Time				06/04/2018 02:52:31 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	041	0	2019	Utica-Rome Metro Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	043	0	1	04	01	H3335_043_0	3	1				05/30/2018	2019.01	05/30/2018 02:47:18 PM Eastern Daylight Time	06/04/2018 02:51:55 PM Eastern Daylight Time				06/04/2018 02:52:31 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	043	0	2019	Central New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	044	0	1	04	01	H3335_044_0	3	1				05/30/2018	2019.01	05/30/2018 02:47:55 PM Eastern Daylight Time	06/04/2018 02:51:55 PM Eastern Daylight Time				06/04/2018 02:52:31 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	044	0	2019	East New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	051	0	1	04	01	H3335_051_0	4	1				08/05/2018	2019.01	08/05/2018 09:17:32 PM Eastern Daylight Time	08/06/2018 01:52:10 PM Eastern Daylight Time	08/06/2018 01:52:11 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic (PPO)	01	04		1			H3335	051	0	2019	Utica-Rome Metro Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	053	0	1	04	01	H3335_053_0	4	1				08/05/2018	2019.01	08/05/2018 09:19:43 PM Eastern Daylight Time	08/06/2018 01:52:13 PM Eastern Daylight Time	08/06/2018 01:52:14 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEssential (PPO)	01	04		1			H3335	053	0	2019	Central New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	054	0	1	04	01	H3335_054_0	4	1				08/05/2018	2019.01	08/05/2018 09:16:53 PM Eastern Daylight Time	08/06/2018 01:52:15 PM Eastern Daylight Time	08/06/2018 01:52:17 PM Eastern Daylight Time			08/06/2018 02:41:12 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEssential (PPO)	01	04		1			H3335	054	0	2019	Utica-Rome Metro Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	801	0	1	04	01	H3335_801_0	2	1				05/25/2018	2019.01	05/25/2018 12:15:35 PM Eastern Daylight Time					06/03/2018 09:37:35 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera Medicare PPO Group (PPO)	01	04		1			H3335	801	0	2019	Western New York		1	2274	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	811	0	1	04	01	H3335_811_0	2	1				05/25/2018	2019.01	05/25/2018 12:16:09 PM Eastern Daylight Time					06/03/2018 09:37:35 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	01	04		1			H3335	811	0	2019	National and Puerto Rico		1	131951	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	813	0	1	04	01	H3335_813_0	2	1				05/25/2018	2019.01	05/25/2018 12:16:17 PM Eastern Daylight Time					06/03/2018 09:37:35 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera Medicare PPO Group (PPO)	01	04		1			H3335	813	0	2019	Western New York		1	0	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	819	0	1	04	01	H3335_819_0	2	1				05/25/2018	2019.01	05/25/2018 12:16:25 PM Eastern Daylight Time					06/03/2018 09:37:35 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	01	04		1			H3335	819	0	2019	National and Puerto Rico		1	0	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	820	0	1	04	01	H3335_820_0	2	1				05/25/2018	2019.01	05/25/2018 12:16:31 PM Eastern Daylight Time					06/03/2018 09:37:35 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group Non-Calendar (PPO)	01	04		1			H3335	820	0	2019	National and Puerto Rico		1	0	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	822	0	1	04	01	H3335_822_0	2	1				05/25/2018	2019.01	05/25/2018 12:16:37 PM Eastern Daylight Time					06/03/2018 09:37:35 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera Medicare PPO Group Non-Calendar (PPO)	01	04		1			H3335	822	0	2019	Western New York		1	0	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3342	019	0	1	04	01	H3342_019_0	6	1				08/03/2018	2019.01	08/03/2018 09:48:22 PM Eastern Daylight Time	08/06/2018 12:09:30 AM Eastern Daylight Time	08/01/2018 08:00:09 PM Eastern Daylight Time			08/06/2018 06:18:09 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Access (PPO)	01	04		1			H3342	019	0	2019	Albany, Rensselaer, Saratoga, Schoharie		2	5819	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)395-5175		(866)395-5175		(800)797-6308		(800)797-6308		(866)395-5175		(866)395-5175		(844)364-2114		(844)364-2114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3342	808	0	1	04	01	H3342_808_0	2	1				06/19/2018	2019.01	06/19/2018 12:54:39 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	808	0	2019	New York		1	25416	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	809	0	1	04	01	H3342_809_0	2	1				06/19/2018	2019.01	06/19/2018 12:54:47 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	809	0	2019	New York		1	1927	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	810	0	1	04	01	H3342_810_0	2	1				06/19/2018	2019.01	06/19/2018 12:54:57 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	810	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	812	0	1	04	01	H3342_812_0	2	1				06/19/2018	2019.01	06/19/2018 12:55:31 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	812	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	813	0	2	04	01	H3342_813_0	2	1				06/19/2018	2019.01	06/19/2018 12:55:47 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	813	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	814	0	2	04	01	H3342_814_0	2	1				06/19/2018	2019.01	06/19/2018 12:56:04 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	814	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	815	0	2	04	01	H3342_815_0	2	1				06/19/2018	2019.01	06/19/2018 12:56:15 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	815	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	816	0	2	04	01	H3342_816_0	3	1				06/19/2018	2019.01	06/19/2018 12:56:28 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	816	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	817	0	1	04	01	H3342_817_0	2	1				06/19/2018	2019.01	06/19/2018 12:56:43 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	817	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	818	0	1	04	01	H3342_818_0	2	1				06/19/2018	2019.01	06/19/2018 12:56:56 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	818	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	819	0	1	04	01	H3342_819_0	2	1				06/19/2018	2019.01	06/19/2018 12:57:10 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	819	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	820	0	1	04	01	H3342_820_0	2	1				06/19/2018	2019.01	06/19/2018 12:57:24 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	820	0	2019	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3344	005	0	1	04	01	H3344_005_0	7	1				07/17/2018	2019.01	07/17/2018 11:12:14 AM Eastern Daylight Time	08/01/2018 10:53:28 AM Eastern Daylight Time	07/31/2018 02:50:06 PM Eastern Daylight Time			08/07/2018 02:55:09 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare Passport Advantage (PPO)	01	04		1			H3344	005	0	2019	Western New York		2		2			2						www.independentheatlh.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2						2			
H3344	801	0	1	04	01	H3344_801_0	1	1				06/01/2018	2019.01	06/01/2018 01:07:29 PM Eastern Daylight Time					06/01/2018 01:09:16 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	01	04		1			H3344	801	0	2019	IH Network and Medicare Deemed Network		1	23715	2			2						www.independentheatlh.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1									
H3344	804	0	1	04	01	H3344_804_0	1	1				06/01/2018	2019.01	06/01/2018 01:07:39 PM Eastern Daylight Time					06/01/2018 01:09:16 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	01	04		1			H3344	804	0	2019	IH Network and Medicare Deemed Network		1	17873	2			2						www.independentheatlh.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1									
H3347	002	0	1	01	01	H3347_002_0	6	1	2	1		08/03/2018	2019.01	08/03/2018 11:00:00 AM Eastern Daylight Time	08/03/2018 04:43:31 PM Eastern Daylight Time	08/03/2018 04:43:29 PM Eastern Daylight Time			08/03/2018 05:33:39 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan For Medicaid Beneficiaries (HMO SNP)	01	01		1			H3347	002	0	2019	Brx, Ki, Na, NY, Qu, Wes		2	60630	2			1	3		2		2	www.caremark.com	www.elderplan.org	www.elderplan.org	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3347	003	0	1	01	01	H3347_003_0	5	1		1		08/03/2018	2019.01	08/03/2018 11:01:30 AM Eastern Daylight Time	08/03/2018 04:43:27 PM Eastern Daylight Time	08/03/2018 04:43:24 PM Eastern Daylight Time			08/03/2018 05:33:39 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Advantage For Nursing Home Residents (HMO SNP)	01	01		1			H3347	003	0	2019	Brx, Ki, Monr, Na, NY, Qu, Ri, Suf, Wes		2	21990	2			1	1	1				www.caremark.com	www.elderplan.org	www.elderplan.org	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3347	007	0	1	01	01	H3347_007_0	6	1	2	1		08/03/2018	2019.01	08/03/2018 11:06:36 AM Eastern Daylight Time	08/03/2018 04:43:21 PM Eastern Daylight Time	08/03/2018 04:43:18 PM Eastern Daylight Time			08/03/2018 05:33:39 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Plus Long Term Care (HMO SNP)	01	01		1			H3347	007	0	2019	Brx, Ki, Na, NY, Qu, Ri, Wes		2	18750	2			1	3		2		1	www.caremark.com	www.elderplan.org	www.elderplan.org	(877)891-6447		(718)921-7979		(866)695-8101		(866)695-8101		(877)891-6447		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3347	009	0	1	01	01	H3347_009_0	5	1				08/03/2018	2019.01	08/03/2018 11:04:53 AM Eastern Daylight Time	08/03/2018 04:43:14 PM Eastern Daylight Time	08/03/2018 04:42:31 PM Eastern Daylight Time			08/03/2018 05:33:39 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Extra Help (HMO)	01	01		1			H3347	009	0	2019	Brx, Ki, NY, Qu, Wes		2	44640	2			2						www.caremark.com	www.elderplan.org	www.elderplan.org	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3351	001	0	1	02	01	H3351_001_0	6	1				06/08/2018	2019.01	06/08/2018 03:16:33 PM Eastern Daylight Time	06/04/2018 02:51:55 PM Eastern Daylight Time				06/08/2018 03:18:41 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Select (HMO-POS)	01	02		1			H3351	001	0	2019	Western New York		2		2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	002	0	1	02	01	H3351_002_0	6	1				05/29/2018	2019.01	05/29/2018 02:34:42 PM Eastern Daylight Time	08/06/2018 01:50:18 PM Eastern Daylight Time	08/06/2018 01:50:24 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Secure (HMO-POS)	01	02		1			H3351	002	0	2019	Western New York		2		2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	006	0	1	02	01	H3351_006_0	7	1				05/29/2018	2019.01	05/29/2018 02:34:56 PM Eastern Daylight Time	08/06/2018 01:50:26 PM Eastern Daylight Time	08/06/2018 01:50:28 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Optimum (HMO-POS)	01	02		1			H3351	006	0	2019	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	007	0	1	02	01	H3351_007_0	6	1				05/29/2018	2019.01	05/29/2018 02:35:11 PM Eastern Daylight Time	06/04/2018 02:51:55 PM Eastern Daylight Time				06/04/2018 02:56:10 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Platinum (HMO-POS)	01	02		1			H3351	007	0	2019	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	010	0	1	01	01	H3351_010_0	6	1				08/05/2018	2019.01	08/05/2018 09:12:22 PM Eastern Daylight Time	08/06/2018 01:50:33 PM Eastern Daylight Time	08/06/2018 01:50:43 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value (HMO)	01	01		1			H3351	010	0	2019	Western New York		2		2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	011	0	1	01	01	H3351_011_0	7	1				08/05/2018	2019.01	08/05/2018 09:15:23 PM Eastern Daylight Time	08/06/2018 01:50:45 PM Eastern Daylight Time	08/06/2018 01:50:48 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Value (HMO)	01	01		1			H3351	011	0	2019	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	012	0	1	02	01	H3351_012_0	7	1				08/05/2018	2019.01	08/05/2018 09:13:11 PM Eastern Daylight Time	08/06/2018 01:50:57 PM Eastern Daylight Time	08/06/2018 01:50:58 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value Plus (HMO-POS)	01	02		1			H3351	012	0	2019	Western New York		2		2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	013	0	1	02	01	H3351_013_0	7	1				08/05/2018	2019.01	08/05/2018 09:16:02 PM Eastern Daylight Time	08/06/2018 01:50:59 PM Eastern Daylight Time	08/06/2018 01:51:01 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Value Plus (HMO-POS)	01	02		1			H3351	013	0	2019	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	015	0	1	02	01	H3351_015_0	6	1				08/05/2018	2019.01	08/05/2018 09:22:39 PM Eastern Daylight Time	08/06/2018 01:51:02 PM Eastern Daylight Time	08/06/2018 01:51:04 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Bassett (HMO-POS)	01	02		1			H3351	015	0	2019	East New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(844)854-4063		(844)854-4063		(800)659-1986		(800)659-1986		(844)854-4063		(844)854-4063		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	016	0	1	01	01	H3351_016_0	7	1				08/05/2018	2019.01	08/05/2018 09:14:08 PM Eastern Daylight Time	08/06/2018 01:51:06 PM Eastern Daylight Time	08/06/2018 01:51:07 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Select (HMO)	01	01		1			H3351	016	0	2019	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	017	0	1	01	01	H3351_017_0	6	1				08/05/2018	2019.01	08/05/2018 09:11:09 PM Eastern Daylight Time	08/06/2018 01:51:16 PM Eastern Daylight Time	08/06/2018 01:51:18 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Basic (HMO)	01	01		1			H3351	017	0	2019	Western New York		2		2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	018	0	1	02	01	H3351_018_0	7	1				08/05/2018	2019.01	08/05/2018 09:14:44 PM Eastern Daylight Time	08/06/2018 01:51:20 PM Eastern Daylight Time	08/06/2018 01:51:21 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Advanced (HMO-POS)	01	02		1			H3351	018	0	2019	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	019	0	1	02	01	H3351_019_0	7	1				08/05/2018	2019.01	08/05/2018 09:11:49 PM Eastern Daylight Time	08/06/2018 01:51:24 PM Eastern Daylight Time	08/06/2018 01:51:25 PM Eastern Daylight Time			08/06/2018 02:29:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Advanced (HMO-POS)	01	02		1			H3351	019	0	2019	Western New York		2		2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	801	0	1	02	01	H3351_801_0	2	1				05/25/2018	2019.01	05/25/2018 12:17:07 PM Eastern Daylight Time					06/03/2018 10:43:14 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice - Group (HMO-POS)	01	02		1			H3351	801	0	2019	Western New York		1	2901	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	802	0	1	02	01	H3351_802_0	2	1				05/29/2018	2019.01	05/29/2018 02:24:32 PM Eastern Daylight Time					06/03/2018 10:43:14 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice - Group (HMO-POS)	01	02		1			H3351	802	0	2019	Metro Rochester Area and Central New York		1	191354	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	803	0	1	02	01	H3351_803_0	2	1				05/25/2018	2019.01	05/25/2018 12:18:14 PM Eastern Daylight Time					06/03/2018 10:43:14 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice - Group (HMO-POS)	01	02		1			H3351	803	0	2019	Western New York		1	48	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	804	0	1	02	01	H3351_804_0	2	1				05/25/2018	2019.01	05/25/2018 12:18:30 PM Eastern Daylight Time					06/03/2018 10:43:14 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice - Group (HMO-POS)	01	02		1			H3351	804	0	2019	Metro Rochester Area and Central New York		1	1905	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	805	0	1	02	01	H3351_805_0	2	1				05/25/2018	2019.01	05/25/2018 12:18:41 PM Eastern Daylight Time					06/03/2018 10:43:14 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Group Non-Calendar (HMO-POS)	01	02		1			H3351	805	0	2019	Western New York		1	0	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	806	0	1	02	01	H3351_806_0	2	1				05/25/2018	2019.01	05/25/2018 12:18:46 PM Eastern Daylight Time					06/03/2018 10:43:14 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Group Non-Calendar (HMO-POS)	01	02		1			H3351	806	0	2019	Metro Rochester Area and Central New York		1	0	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3359	001	0	1	01	01	H3359_001_0	3	1				08/06/2018	2019.01	08/06/2018 05:16:02 PM Eastern Daylight Time	08/06/2018 05:19:12 PM Eastern Daylight Time	08/06/2018 05:22:59 PM Eastern Daylight Time			08/06/2018 05:26:15 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst 65 Plus Plan (HMO)	01	01		1			H3359	001	0	2019	New York City and Nassau County		2		2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	019	0	1	01	01	H3359_019_0	3	1				08/06/2018	2019.01	08/06/2018 04:26:12 PM Eastern Daylight Time	08/06/2018 05:21:08 PM Eastern Daylight Time	08/06/2018 05:23:18 PM Eastern Daylight Time			08/06/2018 05:29:34 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Increased Benefits Plan (HMO)	01	01		1			H3359	019	0	2019	New York City and Nassau County		2		2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	021	0	1	01	01	H3359_021_0	3	1	2	1		08/06/2018	2019.01	08/06/2018 05:16:43 PM Eastern Daylight Time	08/06/2018 05:21:49 PM Eastern Daylight Time	08/06/2018 05:23:38 PM Eastern Daylight Time			08/06/2018 05:31:51 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Life Improvement Plan (HMO SNP)	01	01		1			H3359	021	0	2019	New York City, Nassau and Westchester Counties		2		2			1	3		1		2	www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	027	0	1	01	01	H3359_027_0	2	1				06/04/2018	2019.01	06/04/2018 02:38:23 PM Eastern Daylight Time	06/04/2018 03:20:31 PM Eastern Daylight Time				06/04/2018 03:24:13 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Coordinated Benefits Plan (HMO)	01	01		1			H3359	027	0	2019	New York City and Nassau County		2		2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303										(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821										2					2					2	2			
H3359	034	0	1	01	01	H3359_034_0	3	1	2	1		08/06/2018	2019.01	08/06/2018 05:17:04 PM Eastern Daylight Time	08/06/2018 05:22:29 PM Eastern Daylight Time	08/06/2018 05:24:01 PM Eastern Daylight Time			08/06/2018 05:33:53 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst CompleteCare (HMO SNP)	01	01		1			H3359	034	0	2019	New York City, Nassau, and Westchester Counties		2		2			1	3		1		1	www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	808	0	1	01	01	H3359_808_0	2	1				06/04/2018	2019.01	06/04/2018 11:30:31 AM Eastern Daylight Time					06/04/2018 03:24:13 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Employer Group 1 (HMO)	01	01		1			H3359	808	0	2019	United States		1	120	2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare			(888)260-1010				(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	809	0	1	01	01	H3359_809_0	2	1				06/04/2018	2019.01	06/04/2018 11:45:34 AM Eastern Daylight Time					06/04/2018 03:24:13 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Employer Group 2 (HMO)	01	01		1			H3359	809	0	2019	United States		1	120	2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare			(888)260-1010				(877)237-1303										(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821										2					2					2	2			
H3362	016	0	1	01	01	H3362_016_0	4	1				07/20/2018	2019.01	07/20/2018 09:34:49 AM Eastern Daylight Time	07/17/2018 10:05:26 AM Eastern Daylight Time				07/24/2018 02:06:00 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 (HMO)	01	01		1			H3362	016	0	2019	Western New York		2		2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										2					2					2	2			
H3362	017	0	1	01	01	H3362_017_0	8	1				08/02/2018	2019.01	08/02/2018 04:47:53 PM Eastern Daylight Time	08/01/2018 10:54:16 AM Eastern Daylight Time	07/31/2018 02:50:38 PM Eastern Daylight Time			08/07/2018 02:55:09 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 Basic (HMO)	01	01		1			H3362	017	0	2019	Western New York		2		2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	020	0	1	01	01	H3362_020_0	6	1		1		08/02/2018	2019.01	08/02/2018 04:47:32 PM Eastern Daylight Time	08/02/2018 09:49:32 AM Eastern Daylight Time	07/31/2018 02:51:44 PM Eastern Daylight Time			08/07/2018 02:55:09 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Family Choice (HMO SNP)	01	01		1			H3362	020	0	2019	Western New York		2		2			1	1	3				www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	033	0	1	01	01	H3362_033_0	8	1				07/17/2018	2019.01	07/17/2018 11:15:44 AM Eastern Daylight Time	08/01/2018 10:55:58 AM Eastern Daylight Time	07/31/2018 02:51:10 PM Eastern Daylight Time			08/07/2018 02:55:09 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Core (HMO)	01	01		1			H3362	033	0	2019	Western New York		2		2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	035	0	1	01	01	H3362_035_0	7	1		1		07/25/2018	2019.01	07/25/2018 02:47:15 PM Eastern Daylight Time	08/01/2018 10:56:48 AM Eastern Daylight Time	07/31/2018 02:49:26 PM Eastern Daylight Time			08/07/2018 02:55:09 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com	Encompass 65 C-SNP (HMO SNP)	01	01		1			H3362	035	0	2019	Erie County		2		2			1	4			00000000000000000100		www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	801	0	1	01	01	H3362_801_0	1	1				06/01/2018	2019.01	06/01/2018 12:55:04 PM Eastern Daylight Time					06/01/2018 01:16:29 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	01	01		1			H3362	801	0	2019	New York State		1	50123	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3362	807	0	1	02	01	H3362_807_0	1	1				06/01/2018	2019.01	06/01/2018 12:54:57 PM Eastern Daylight Time					06/01/2018 01:16:29 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO-POS)	01	02		1			H3362	807	0	2019	IH Network and Medicare Deemed Network		1	37958	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1				
H3362	819	0	1	02	01	H3362_819_0	1	1				06/01/2018	2019.01	06/01/2018 12:55:55 PM Eastern Daylight Time					06/01/2018 01:16:29 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO-POS)	01	02		1			H3362	819	0	2019	IH Network and Medicare Deemed Network		1	3570	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										1	1	1a;1b;2;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1				
H3362	820	0	1	01	01	H3362_820_0	1	1				06/01/2018	2019.01	06/01/2018 12:56:33 PM Eastern Daylight Time					06/01/2018 01:16:29 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	01	01		1			H3362	820	0	2019	New York State		1	43820	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3379	001	0	1	01	01	H3379_001_0	2	1				05/24/2018	2019.01	05/24/2018 03:18:42 PM Central Daylight Time	08/03/2018 10:14:28 AM Central Daylight Time	07/31/2018 06:52:40 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3379	001	0	2019	New York City Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	002	0	1	01	01	H3379_002_0	2	1		1		05/24/2018	2019.01	05/24/2018 06:35:15 PM Central Daylight Time	08/03/2018 10:14:58 AM Central Daylight Time	07/31/2018 06:53:10 PM Central Daylight Time			08/06/2018 10:50:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO SNP)	01	01		1			H3379	002	0	2019	New York City metro area		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	022	0	1	01	01	H3379_022_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:56:20 PM Central Daylight Time	08/03/2018 10:15:29 AM Central Daylight Time	07/31/2018 06:53:34 PM Central Daylight Time			08/06/2018 10:50:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO SNP)	01	01		1			H3379	022	0	2019	Upstate New York		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	039	0	1	01	01	H3379_039_0	3	1				08/02/2018	2019.01	08/02/2018 02:18:06 PM Central Daylight Time	08/03/2018 10:15:59 AM Central Daylight Time	07/31/2018 06:53:58 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H3379	039	0	2019	Syracuse Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	040	0	1	01	01	H3379_040_0	4	1				08/02/2018	2019.01	08/02/2018 02:19:03 PM Central Daylight Time	08/03/2018 10:16:29 AM Central Daylight Time	07/31/2018 06:54:20 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H3379	040	0	2019	Buffalo Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	041	0	1	01	01	H3379_041_0	4	1				08/02/2018	2019.01	08/02/2018 02:19:42 PM Central Daylight Time	08/03/2018 10:16:59 AM Central Daylight Time	07/31/2018 06:54:48 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H3379	041	0	2019	Monroe and Wayne counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	042	0	1	01	01	H3379_042_0	4	1		1		08/02/2018	2019.01	08/02/2018 02:56:41 PM Central Daylight Time	08/03/2018 10:17:29 AM Central Daylight Time	07/31/2018 06:55:12 PM Central Daylight Time			08/06/2018 10:50:25 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO SNP)	01	01		1			H3379	042	0	2019	Jefferson County		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	013	0	1	01	01	H3384_013_0	6	1				08/03/2018	2019.01	08/03/2018 09:23:27 AM Eastern Daylight Time	08/07/2018 02:20:30 PM Eastern Daylight Time	08/07/2018 02:20:39 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Senior Blue 652 (HMO)	01	01		1			H3384	013	0	2019	Northeastern New York		2		2			2						www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	019	0	1	01	01	H3384_019_0	6	1				08/03/2018	2019.01	08/03/2018 09:24:11 AM Eastern Daylight Time	08/07/2018 02:20:31 PM Eastern Daylight Time	08/07/2018 02:20:39 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue 651 (HMO)	01	01		1			H3384	019	0	2019	Western New York		2		2			2						www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	022	0	1	01	01	H3384_022_0	5	1				07/12/2018	2019.01	07/12/2018 12:18:59 PM Eastern Daylight Time	07/20/2018 01:16:15 PM Eastern Daylight Time				07/20/2018 01:20:31 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue 601 (HMO)	01	01		1			H3384	022	0	2019	Western New York		2		2			2						www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3384	058	0	1	01	01	H3384_058_0	5	1				08/03/2018	2019.01	08/03/2018 09:24:58 AM Eastern Daylight Time	08/07/2018 02:20:31 PM Eastern Daylight Time	08/07/2018 02:20:39 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue Select (HMO)	01	01		1			H3384	058	0	2019	Western New York		2		2			2						www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	059	0	1	02	01	H3384_059_0	6	1				08/03/2018	2019.01	08/03/2018 09:25:38 AM Eastern Daylight Time	08/07/2018 02:20:32 PM Eastern Daylight Time	08/07/2018 02:20:40 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Freedom Plus (HMO-POS)	01	02		1			H3384	059	0	2019	Northeastern New York		2		2			2						www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	062	0	1	01	01	H3384_062_0	6	1				08/03/2018	2019.01	08/03/2018 09:26:12 AM Eastern Daylight Time	08/07/2018 02:20:32 PM Eastern Daylight Time	08/07/2018 02:20:40 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield BlueSaver (HMO)	01	01		1			H3384	062	0	2019	Western New York		2		2			2						www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	063	0	1	02	01	H3384_063_0	5	1				08/03/2018	2019.01	08/03/2018 09:26:53 AM Eastern Daylight Time	08/07/2018 02:20:33 PM Eastern Daylight Time	08/07/2018 02:20:40 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Freedom Value (HMO-POS)	01	02		1			H3384	063	0	2019	Northeastern New York		2		2			2						www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	064	0	1	02	01	H3384_064_0	5	1				08/03/2018	2019.01	08/03/2018 09:27:20 AM Eastern Daylight Time	08/07/2018 02:20:33 PM Eastern Daylight Time	08/07/2018 02:20:40 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Freedom Premier (HMO-POS)	01	02		1			H3384	064	0	2019	Northeastern New York		2		2			2						www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	805	0	1	01	01	H3384_805_0	2	1				06/01/2018	2019.01	06/01/2018 01:13:17 PM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMO Group MA Only Plan (HMO)	01	01		1			H3384	805	0	2019	Western and Northeastern New York		1	98	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1					2				
H3384	806	0	1	01	01	H3384_806_0	2	1				06/01/2018	2019.01	06/01/2018 01:13:39 PM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMO Group (MA-PD) Calendar Year (HMO)	01	01		1			H3384	806	0	2019	Western and Northeastern New York		1	50181	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;	2		1					1				
H3384	811	0	1	02	01	H3384_811_0	2	1				06/01/2018	2019.01	06/01/2018 01:14:36 PM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	HMOPOS Group (MA-PD) Calendar Year (HMO-POS)	01	02		1			H3384	811	0	2019	Western and Northeastern New York		1	1200	2			2						www.bcbswny.com	www.bcbswny.com/medicare	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1	2		2		1				
H3384	812	0	1	02	01	H3384_812_0	2	1				06/01/2018	2019.01	06/01/2018 01:14:45 PM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	HMOPOS Group MA Only Calendar Year (HMO-POS)	01	02		1			H3384	812	0	2019	Western and Northeastern New York		1	1200	2			2						www.bcbswny.com	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1				
H3387	010	0	1	01	01	H3387_010_0	3	1	2	1		06/01/2018	2019.01	06/01/2018 10:52:00 AM Central Daylight Time	08/03/2018 10:20:01 AM Central Daylight Time	07/31/2018 06:55:38 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3387	010	0	2019	Select Counties in New York		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)514-4912		(800)514-4912		(888)834-3721		(888)834-3721		(800)514-4912		(800)514-4912		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3388	001	0	1	01	01	H3388_001_0	10	1				07/13/2018	2019.01	07/13/2018 11:50:10 AM Eastern Daylight Time	07/03/2018 10:54:18 AM Eastern Daylight Time				07/13/2018 12:06:31 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices		CDPHP Choice (HMO)	01	01		1			H3388	001	0	2019	Greater Capital Region of New York State		2	10026	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7a;	
H3388	002	0	1	01	01	H3388_002_0	14	1				07/30/2018	2019.01	07/30/2018 08:46:56 AM Eastern Daylight Time	08/06/2018 03:47:42 PM Eastern Daylight Time	08/03/2018 02:51:12 PM Eastern Daylight Time			08/07/2018 01:12:28 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Choice Rx (HMO)	01	01		1			H3388	002	0	2019	Greater Capital Region of New York State		2	163620	2			2						http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	http://www.CDPHP.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3388	004	0	1	01	01	H3388_004_0	13	1				08/06/2018	2019.01	08/06/2018 11:16:43 AM Eastern Daylight Time	08/06/2018 01:02:10 PM Eastern Daylight Time	08/03/2018 03:03:10 PM Eastern Daylight Time			08/07/2018 01:12:28 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Value Rx (HMO)	01	01		1			H3388	004	0	2019	Greater Capital Region of New York State		2	124782	2			2						http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	http://www.CDPHP.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3388	013	0	1	01	01	H3388_013_0	12	1				08/06/2018	2019.01	08/06/2018 11:17:28 AM Eastern Daylight Time	08/03/2018 02:03:12 PM Eastern Daylight Time	08/03/2018 03:04:04 PM Eastern Daylight Time			08/06/2018 11:22:58 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Basic RX (HMO)	01	01		1			H3388	013	0	2019	Greater Capital Region of New York State		2	43272	2			2						http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	http://www.CDPHP.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3388	014	0	1	01	01	H3388_014_0	13	1				08/06/2018	2019.01	08/06/2018 11:18:41 AM Eastern Daylight Time	08/03/2018 02:06:46 PM Eastern Daylight Time	08/03/2018 03:05:10 PM Eastern Daylight Time			08/06/2018 11:22:58 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP $0 Medicare Rx (HMO)	01	01		1			H3388	014	0	2019	Greater Capital Region of New York State		2	17688	2			2						http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	http://www.CDPHP.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3388	801	0	1	01	01	H3388_801_0	4	1				07/03/2018	2019.01	07/03/2018 12:54:39 PM Eastern Daylight Time					07/06/2018 11:16:20 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	801	0	2019	Greater Capital Region of New York State		1	36	2			2						http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	http://www.CDPHP.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7g;7h;7i;8a;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;14d;	1					1				
H3388	803	0	1	01	01	H3388_803_0	4	1				07/03/2018	2019.01	07/03/2018 12:53:22 PM Eastern Daylight Time					07/06/2018 11:16:20 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	803	0	2019	Greater Capital Region of New York State		1	110926	2			2						http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	http://www.CDPHP.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7g;7h;7i;8a;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;14d;	1					1				
H3388	804	0	1	01	01	H3388_804_0	4	1				07/06/2018	2019.01	07/06/2018 11:15:56 AM Eastern Daylight Time					07/06/2018 11:16:20 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare (HMO)	01	01		1			H3388	804	0	2019	Greater Capital Region of New York State		1	3497	2			2						http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	http://www.CDPHP.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7c;7e;7g;7h;7i;8a;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;14d;	1					1				
H3404	003	1	1	04	01	H3404_003_1	3	1				06/22/2018	2019.01	06/22/2018 12:38:36 PM Eastern Daylight Time	08/03/2018 02:34:42 PM Eastern Daylight Time	08/03/2018 03:27:12 PM Eastern Daylight Time			08/07/2018 11:47:48 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO Enhanced (PPO)	01	04		1			H3404	003	1	2019	Select North Carolina Counties	PPO Region 1	2	188265	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2						2			
H3404	003	2	1	04	01	H3404_003_2	3	1				05/29/2018	2019.01	05/29/2018 11:19:42 AM Eastern Daylight Time	08/03/2018 02:36:16 PM Eastern Daylight Time	08/03/2018 03:26:26 PM Eastern Daylight Time			08/07/2018 11:47:48 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO Enhanced (PPO)	01	04		1			H3404	003	2	2019	Select North Carolina Counties	PPO Region 2	2	144900	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2						2			
H3404	801	0	1	04	01	H3404_801_0	2	1				05/22/2018	2019.01	05/22/2018 12:24:20 PM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP Medical Only (PPO)	01	04		1			H3404	801	0	2019	North Carolina Employer Groups		1	0	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										1	1	1a;1b;2;3-1;5;6;7e;7f;7h;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;15;16b;	2		1									
H3404	803	0	1	04	01	H3404_803_0	2	1				05/22/2018	2019.01	05/22/2018 12:20:57 PM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP (PPO)	01	04		1			H3404	803	0	2019	North Carolina Employer Groups		1	2137	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	1	1a;1b;2;3-1;5;6;7e;7f;7h;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;15;16b;	2		1									
H3404	809	0	1	04	01	H3404_809_0	2	1				05/22/2018	2019.01	05/22/2018 12:24:33 PM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP Value (PPO)	01	04		1			H3404	809	0	2019	NC Employer Groups		1	0	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	1	1a;1b;2;3-1;5;6;7e;7f;7h;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;15;16b;	2		1									
H3416	001	4	1	04	01	H3416_001_4	7	1				06/03/2018	2019.01	06/03/2018 06:59:05 PM Central Daylight Time	08/06/2018 09:38:55 AM Central Daylight Time	08/06/2018 09:39:25 AM Central Daylight Time			08/06/2018 09:49:25 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Align (PPO)	01	04		1			H3416	001	4	2019	Central Iowa & Western Illinois	Cedar Rapids, Central IA, and Peoria Areas	2	5279	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	oneplanforme.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	001	5	1	04	01	H3416_001_5	6	1				06/03/2018	2019.01	06/03/2018 06:54:02 PM Central Daylight Time	08/06/2018 09:38:55 AM Central Daylight Time	08/06/2018 09:39:25 AM Central Daylight Time			08/06/2018 09:49:25 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Align (PPO)	01	04		1			H3416	001	5	2019	Central Iowa & Western Illinois	Fort Dodge, Quad Cities, Waterloo Areas	2	5279	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	oneplanforme.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	002	2	1	04	01	H3416_002_2	7	1				06/03/2018	2019.01	06/03/2018 06:54:20 PM Central Daylight Time	08/06/2018 09:38:56 AM Central Daylight Time	08/06/2018 09:39:26 AM Central Daylight Time			08/06/2018 09:49:25 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Symmetry (PPO)	01	04		1			H3416	002	2	2019	Central Iowa & Western Illinois	Cedar Rapids, Central IA, and Peoria Areas	2	3519	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	oneplanforme.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	002	3	1	04	01	H3416_002_3	6	1				06/03/2018	2019.01	06/03/2018 06:54:47 PM Central Daylight Time	08/06/2018 09:38:57 AM Central Daylight Time	08/06/2018 09:39:26 AM Central Daylight Time			08/06/2018 09:49:25 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Symmetry (PPO)	01	04		1			H3416	002	3	2019	Central Iowa & Western Illinois	Fort Dodge, Quad Cities, Waterloo Areas	2	3519	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	oneplanforme.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	801	0	1	04	01	H3416_801_0	2	1				06/01/2018	2019.01	06/01/2018 04:13:54 PM Central Daylight Time					06/03/2018 09:45:32 PM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Group MAPD CY (PPO)	01	04		1			H3416	801	0	2019	Nationwide		1	600	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	oneplanforme.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	803	0	1	04	01	H3416_803_0	2	1				06/01/2018	2019.01	06/01/2018 04:10:12 PM Central Daylight Time					06/03/2018 09:45:32 PM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Group MA Only (PPO)	01	04		1			H3416	803	0	2019	Nationwide		1	0	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	oneplanforme.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3430	001	0	1	20	08	H3430_001_0	1	1				05/25/2018	2019.01	05/25/2018 02:41:00 PM Eastern Daylight Time		05/25/2018 02:25:17 PM Eastern Daylight Time			05/25/2018 02:43:47 PM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	www.suncoastpace.org	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	001	0	2019	Suncoast PACE, Inc., Pinellas County		2		2			2						http://www.suncoastpace.org/	http://www.suncoastpace.org/										(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062										(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062																
H3430	002	0	1	20	08	H3430_002_0	1	1				05/25/2018	2019.01	05/25/2018 02:41:54 PM Eastern Daylight Time		05/25/2018 02:25:17 PM Eastern Daylight Time			05/25/2018 02:43:47 PM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	www.suncoastpace.org	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	002	0	2019	Suncoast PACE, Inc., Pinellas County		2		2			2						http://www.suncoastpace.org/	http://www.suncoastpace.org/										(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062										(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062																
H3447	001	0	1	01	01	H3447_001_0	4	1				05/30/2018	2019.01	05/30/2018 03:34:34 PM Pacific Daylight Time	08/01/2018 03:34:00 PM Pacific Daylight Time	07/31/2018 03:20:09 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Local (HMO)	01	01		1			H3447	001	0	2019	Richmond Metropolitan, West & So. of Richmond Area		2	33791	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	003	0	1	01	01	H3447_003_0	4	1		1		05/30/2018	2019.01	05/30/2018 03:34:48 PM Pacific Daylight Time	08/01/2018 03:39:26 PM Pacific Daylight Time	07/31/2018 03:20:30 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue COPD (HMO SNP)	01	01		1			H3447	003	0	2019	Richmond Metropolitan, West & So. of Richmond Area		2	5857	2			1	4			00000000000100000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	004	0	1	01	01	H3447_004_0	4	1		1		05/30/2018	2019.01	05/30/2018 03:35:13 PM Pacific Daylight Time	08/01/2018 03:38:06 PM Pacific Daylight Time	07/31/2018 03:20:52 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes (HMO SNP)	01	01		1			H3447	004	0	2019	Richmond Metropolitan, West & So. of Richmond Area		2	23539	2			1	4			00000010000000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	005	0	1	01	01	H3447_005_0	4	1				08/01/2018	2019.01	08/01/2018 02:24:24 PM Pacific Daylight Time	08/01/2018 03:35:20 PM Pacific Daylight Time	07/31/2018 03:21:12 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Smart Fit (HMO)	01	01		1			H3447	005	0	2019	Richmond Metropolitan, West & So. of Richmond Area		2	11678	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	010	0	1	01	01	H3447_010_0	5	1		1		08/01/2018	2019.01	08/01/2018 02:25:04 PM Pacific Daylight Time	08/01/2018 03:36:43 PM Pacific Daylight Time	07/31/2018 03:21:32 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO SNP)	01	01		1			H3447	010	0	2019	Richmond Metropolitan, West & So. of Richmond Area		2	2834	2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	011	0	1	01	01	H3447_011_0	11	1	2	1		08/07/2018	2019.01	08/07/2018 08:29:49 AM Eastern Daylight Time	08/06/2018 12:10:33 AM Eastern Daylight Time	08/01/2018 06:59:35 PM Eastern Daylight Time			08/07/2018 02:38:36 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H3447	011	0	2019	Select Counties in Virginia		2	59797	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)363-0724		(855)363-0724		(844)828-1338		(844)828-1338		(855)363-0724		(855)363-0724		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	012	0	1	01	01	H3447_012_0	12	1	2	1		08/03/2018	2019.01	08/03/2018 02:46:57 PM Eastern Daylight Time	08/06/2018 12:11:35 AM Eastern Daylight Time	08/01/2018 07:01:29 PM Eastern Daylight Time			08/06/2018 06:10:11 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H3447	012	0	2019	Select Counties in Virginia		2	22387	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)363-0724		(855)363-0724		(844)828-1338		(844)828-1338		(855)363-0724		(855)363-0724		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	013	0	1	01	01	H3447_013_0	7	1				08/03/2018	2019.01	08/03/2018 10:37:10 AM Eastern Daylight Time	08/06/2018 12:12:36 AM Eastern Daylight Time	08/01/2018 08:00:53 PM Eastern Daylight Time			08/06/2018 06:10:11 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	013	0	2019	Southern Virginia Counties		2	10160	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	014	0	1	01	01	H3447_014_0	6	1				08/03/2018	2019.01	08/03/2018 10:38:57 AM Eastern Daylight Time	08/06/2018 12:13:38 AM Eastern Daylight Time	08/01/2018 08:01:37 PM Eastern Daylight Time			08/06/2018 06:10:11 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	014	0	2019	Northern Virginia Counties		2	4290	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	017	0	1	02	01	H3447_017_0	10	1		1		08/03/2018	2019.01	08/03/2018 09:37:02 PM Eastern Daylight Time		08/01/2018 08:02:22 PM Eastern Daylight Time		08/06/2018 12:14:11 AM Eastern Daylight Time	08/06/2018 06:10:11 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue ESRD (HMO-POS SNP)	01	02		1			H3447	017	0	2019	Select Counties in VA		2	440	2			1	4			00000000100000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	018	0	1	01	01	H3447_018_0	10	1	2	1		08/03/2018	2019.01	08/03/2018 10:34:42 AM Eastern Daylight Time	08/06/2018 12:15:13 AM Eastern Daylight Time	08/01/2018 07:03:19 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H3447	018	0	2019	Select Counties in Missouri		2	48360	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8826		(855)251-8826		(844)373-7111		(844)373-7111		(855)251-8826		(855)251-8826		(844)373-7110		(844)373-7110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	019	0	1	01	01	H3447_019_0	11	1				08/03/2018	2019.01	08/03/2018 10:35:55 AM Eastern Daylight Time	08/06/2018 12:16:15 AM Eastern Daylight Time	08/01/2018 08:03:07 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	019	0	2019	Select Counties in Missouri		2	168528	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8826		(855)251-8826		(844)373-7111		(844)373-7111		(855)251-8826		(855)251-8826		(844)373-7110		(844)373-7110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	020	0	1	01	01	H3447_020_0	10	1	2	1		08/03/2018	2019.01	08/03/2018 10:52:43 AM Eastern Daylight Time	08/06/2018 12:17:17 AM Eastern Daylight Time	08/01/2018 07:05:26 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H3447	020	0	2019	Select Counties in Indiana		2	126144	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	021	0	1	01	01	H3447_021_0	11	1				08/03/2018	2019.01	08/03/2018 10:36:50 AM Eastern Daylight Time	08/06/2018 12:18:33 AM Eastern Daylight Time	08/01/2018 08:03:52 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	021	0	2019	Select counties in Indiana		2	57960	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	022	0	1	01	01	H3447_022_0	11	1				08/03/2018	2019.01	08/03/2018 10:38:09 AM Eastern Daylight Time	08/06/2018 12:20:00 AM Eastern Daylight Time	08/01/2018 08:04:36 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	022	0	2019	Select Counties in Indiana		2	46008	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	023	0	1	01	01	H3447_023_0	11	1				08/03/2018	2019.01	08/03/2018 10:39:14 AM Eastern Daylight Time	08/06/2018 12:21:08 AM Eastern Daylight Time	08/01/2018 08:05:21 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	023	0	2019	Select Counties in Indiana		2	97032	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	024	0	1	01	01	H3447_024_0	11	1				08/03/2018	2019.01	08/03/2018 10:39:49 AM Eastern Daylight Time	08/06/2018 12:22:10 AM Eastern Daylight Time	08/01/2018 08:06:06 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3447	024	0	2019	Select Counties in Indiana		2	4440	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	801	0	1	01	01	H3447_801_0	1	1				05/24/2018	2019.01	05/24/2018 07:41:10 PM Pacific Daylight Time					05/31/2018 06:30:33 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue EGWP (HMO)	01	01		1			H3447	801	0	2019	Virginia		1	175	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)295-7811		(855)295-7811		(888)649-5968		(888)649-5968										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3447	802	0	1	01	01	H3447_802_0	1	1				04/30/2018	2019.01	04/30/2018 04:51:28 PM Pacific Daylight Time					05/31/2018 06:30:33 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue EGWP MAPD (HMO)	01	01		1			H3447	802	0	2019	Virginia		1	175	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)295-7811		(855)295-7811		(888)649-5968		(888)649-5968		(855)295-7811		(855)295-7811		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	803	0	1	01	01	H3447_803_0	1	1				04/30/2018	2019.01	04/30/2018 04:54:31 PM Pacific Daylight Time					05/31/2018 06:30:33 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue EGWP MAPD (HMO)	01	01		1			H3447	803	0	2019	Virginia		1	65	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)295-7811		(855)295-7811		(888)649-5968		(888)649-5968		(855)295-7811		(855)295-7811		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	804	0	1	01	01	H3447_804_0	4	1				06/19/2018	2019.01	06/19/2018 01:08:30 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	804	0	2019	Select counties in Virginia		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	805	0	1	01	01	H3447_805_0	3	1				06/19/2018	2019.01	06/19/2018 01:08:34 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	805	0	2019	Select counties in Virginia		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	806	0	2	01	01	H3447_806_0	3	1				06/19/2018	2019.01	06/19/2018 01:09:30 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	806	0	2019	Virginia - Select Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	807	0	2	01	01	H3447_807_0	3	1				06/19/2018	2019.01	06/19/2018 01:09:18 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	807	0	2019	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	808	0	1	01	01	H3447_808_0	3	1				06/19/2018	2019.01	06/19/2018 01:09:26 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	808	0	2019	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	809	0	1	01	01	H3447_809_0	3	1				06/19/2018	2019.01	06/19/2018 01:09:53 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	809	0	2019	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	810	0	2	01	01	H3447_810_0	3	1				06/19/2018	2019.01	06/19/2018 01:10:01 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	810	0	2019	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	811	0	1	01	01	H3447_811_0	3	1				06/19/2018	2019.01	06/19/2018 01:10:11 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	811	0	2019	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	812	0	1	01	01	H3447_812_0	3	1				06/19/2018	2019.01	06/19/2018 01:10:18 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	812	0	2019	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	813	0	2	01	01	H3447_813_0	3	1				06/19/2018	2019.01	06/19/2018 01:10:43 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	813	0	2019	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	814	0	2	01	01	H3447_814_0	3	1				06/19/2018	2019.01	06/19/2018 01:10:56 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	814	0	2019	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	815	0	1	01	01	H3447_815_0	3	1				06/19/2018	2019.01	06/19/2018 01:11:03 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	815	0	2019	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	816	0	1	01	01	H3447_816_0	3	1				06/19/2018	2019.01	06/19/2018 01:11:10 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	816	0	2019	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	817	0	2	01	01	H3447_817_0	3	1				06/19/2018	2019.01	06/19/2018 01:11:32 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	817	0	2019	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	818	0	1	01	01	H3447_818_0	3	1				06/19/2018	2019.01	06/19/2018 01:11:41 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	818	0	2019	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	819	0	1	01	01	H3447_819_0	3	1				06/19/2018	2019.01	06/19/2018 01:11:49 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	819	0	2019	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	820	0	2	01	01	H3447_820_0	3	1				06/19/2018	2019.01	06/19/2018 01:12:04 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	820	0	2019	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	821	0	2	01	01	H3447_821_0	3	1				06/19/2018	2019.01	06/19/2018 01:12:12 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	821	0	2019	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	822	0	1	01	01	H3447_822_0	3	1				06/19/2018	2019.01	06/19/2018 01:12:18 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	822	0	2019	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	823	0	1	01	01	H3447_823_0	3	1				06/19/2018	2019.01	06/19/2018 01:12:27 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	823	0	2019	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	824	0	2	01	01	H3447_824_0	3	1				06/19/2018	2019.01	06/19/2018 01:12:37 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	824	0	2019	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	825	0	2	01	01	H3447_825_0	3	1				06/19/2018	2019.01	06/19/2018 01:12:55 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	825	0	2019	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	826	0	2	01	01	H3447_826_0	3	1				06/19/2018	2019.01	06/19/2018 01:13:07 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	826	0	2019	Anthem MediBlue		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	827	0	2	01	01	H3447_827_0	3	1				06/19/2018	2019.01	06/19/2018 12:56:26 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	827	0	2019	Select MO Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3449	012	0	1	01	01	H3449_012_0	2	1				05/31/2018	2019.01	05/31/2018 02:19:06 PM Eastern Daylight Time	05/31/2018 02:01:05 PM Eastern Daylight Time				05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO Medical Only (HMO)	01	01		1			H3449	012	0	2019	Select North Carolina Counties		2	79205	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										2					2					2	2			
H3449	023	1	1	01	01	H3449_023_1	3	1				08/07/2018	2019.01	08/07/2018 10:51:34 AM Eastern Daylight Time	08/03/2018 02:43:56 PM Eastern Daylight Time	08/03/2018 03:25:08 PM Eastern Daylight Time			08/07/2018 11:47:48 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO Essential (HMO)	01	01		1			H3449	023	1	2019	Select North Carolina Counties	HMO Essential Region 1	2	45361	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	023	2	1	01	01	H3449_023_2	3	1				05/23/2018	2019.01	05/23/2018 09:12:08 AM Eastern Daylight Time	08/03/2018 02:45:02 PM Eastern Daylight Time	08/03/2018 03:23:58 PM Eastern Daylight Time			08/07/2018 11:47:48 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO Essential (HMO)	01	01		1			H3449	023	2	2019	Select North Carolina Counties	HMO Essential Region 2	2	103944	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	023	4	1	01	01	H3449_023_4	3	1				05/23/2018	2019.01	05/23/2018 09:12:55 AM Eastern Daylight Time	08/03/2018 02:47:50 PM Eastern Daylight Time	08/03/2018 03:22:56 PM Eastern Daylight Time			08/07/2018 11:47:48 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO Essential (HMO)	01	01		1			H3449	023	4	2019	Select North Carolina Counties	HMO Essential Region 3	2	17447	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	024	1	1	01	01	H3449_024_1	3	1				05/22/2018	2019.01	05/22/2018 12:56:14 PM Eastern Daylight Time	08/03/2018 02:48:58 PM Eastern Daylight Time	08/03/2018 03:21:54 PM Eastern Daylight Time			08/07/2018 11:47:48 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO Enhanced (HMO)	01	01		1			H3449	024	1	2019	Select North Carolina Counties	HMO Enhanced Region 1	2	44346	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	024	2	1	01	01	H3449_024_2	3	1				05/22/2018	2019.01	05/22/2018 12:56:29 PM Eastern Daylight Time	08/03/2018 02:32:40 PM Eastern Daylight Time	08/03/2018 03:20:46 PM Eastern Daylight Time			08/07/2018 11:47:48 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO Enhanced (HMO)	01	01		1			H3449	024	2	2019	Select North Carolina Counties	HMO Enhanced Region 2	2	144464	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	801	0	1	01	01	H3449_801_0	2	1				05/23/2018	2019.01	05/23/2018 10:11:19 AM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP (HMO)	01	01		1			H3449	801	0	2019	North Carolina Employer Groups		1	11587	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	1	1a;1b;2;3-1;3-3;5;6;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;15;16b;	2		1					1				
H3449	805	0	1	01	01	H3449_805_0	2	1				05/22/2018	2019.01	05/22/2018 12:24:50 PM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP Medical Only (HMO)	01	01		1			H3449	805	0	2019	North Carolina Employer Groups		1	0	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										1	1	1a;1b;2;3-1;3-3;5;6;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;15;16b;	2		1					1				
H3449	813	0	1	01	01	H3449_813_0	2	1				05/22/2018	2019.01	05/22/2018 12:25:04 PM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP Value (HMO)	01	01		1			H3449	813	0	2019	NC Employer Groups		1	0	2			2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	1	1a;1b;2;3-1;3-3;5;6;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;15;16b;	2		1					1				
H3464	001	0	1	01	01	H3464_001_0	5	1				08/02/2018	2019.01	08/02/2018 12:50:05 PM Central Daylight Time	08/03/2018 10:22:03 AM Central Daylight Time	07/31/2018 06:56:34 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3464	001	0	2019	Fayetteville Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	002	0	1	01	01	H3464_002_0	4	1				07/12/2018	2019.01	07/12/2018 06:38:11 PM Central Daylight Time	08/03/2018 10:22:34 AM Central Daylight Time	07/31/2018 06:56:56 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3464	002	0	2019	Fayetteville Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	003	0	1	01	01	H3464_003_0	6	1				08/10/2018	2019.01	08/10/2018 01:52:18 PM Central Daylight Time	08/10/2018 09:55:46 AM Central Daylight Time	07/31/2018 06:57:18 PM Central Daylight Time			08/10/2018 01:56:10 PM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3464	003	0	2019	Little Rock Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	004	0	1	01	01	H3464_004_0	4	1				07/10/2018	2019.01	07/10/2018 10:16:47 AM Central Daylight Time	08/03/2018 10:23:35 AM Central Daylight Time	07/31/2018 06:57:42 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3464	004	0	2019	Little Rock Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	005	0	1	01	01	H3464_005_0	4	1				08/02/2018	2019.01	08/02/2018 12:52:32 PM Central Daylight Time	08/03/2018 10:24:06 AM Central Daylight Time	07/31/2018 06:58:04 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3464	005	0	2019	Hot Springs Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	006	0	1	01	01	H3464_006_0	4	1				07/10/2018	2019.01	07/10/2018 10:18:04 AM Central Daylight Time	08/03/2018 10:24:39 AM Central Daylight Time	07/31/2018 06:58:28 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3464	006	0	2019	Hot Springs Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	001	0	1	01	01	H3471_001_0	9	1				07/26/2018	2019.01	07/26/2018 08:41:31 AM Central Daylight Time	08/03/2018 03:25:25 PM Central Daylight Time	08/03/2018 01:57:01 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion Rx (HMO)	01	01		1			H3471	001	0	2019	Grant County		2	36452	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	002	0	1	01	01	H3471_002_0	9	1				07/26/2018	2019.01	07/26/2018 08:41:40 AM Central Daylight Time	08/03/2018 03:28:39 PM Central Daylight Time	08/06/2018 09:42:19 AM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion Rx Plus (HMO)	01	01		1			H3471	002	0	2019	Okanogan, Chelan, Douglas, Grant County		2	5062	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	003	0	1	01	01	H3471_003_0	7	1				07/26/2018	2019.01	07/26/2018 08:41:56 AM Central Daylight Time	06/04/2018 01:56:33 AM Central Daylight Time				07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion HMO (HMO)	01	01		1			H3471	003	0	2019	Okanogan, Chelan, Douglas, Grant County		2	2904	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	004	0	1	01	01	H3471_004_0	9	1				07/26/2018	2019.01	07/26/2018 08:42:07 AM Central Daylight Time	08/03/2018 03:31:37 PM Central Daylight Time	08/03/2018 01:58:32 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage HMO Rx (HMO)	01	01		1			H3471	004	0	2019	Yakima County		2	12644	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	005	0	1	01	01	H3471_005_0	9	1				08/02/2018	2019.01	08/02/2018 03:25:19 PM Central Daylight Time	08/03/2018 03:35:02 PM Central Daylight Time	08/03/2018 01:59:15 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage HMO Rx Plus (HMO)	01	01		1			H3471	005	0	2019	Yakima County		2	9544	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	006	0	1	01	01	H3471_006_0	7	1				07/26/2018	2019.01	07/26/2018 08:42:32 AM Central Daylight Time	06/02/2018 08:52:50 PM Central Daylight Time				07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage HMO (HMO)	01	01		1			H3471	006	0	2019	Yakima County		2	1177	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	010	0	1	01	01	H3471_010_0	9	1				08/02/2018	2019.01	08/02/2018 03:25:42 PM Central Daylight Time	08/03/2018 03:38:34 PM Central Daylight Time	08/03/2018 02:00:17 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion Basic Rx (HMO)	01	01		1			H3471	010	0	2019	Okanogan, Chelan, Douglas, Grant County		2	17624	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	013	0	1	02	01	H3471_013_0	9	1				07/26/2018	2019.01	07/26/2018 09:14:32 AM Central Daylight Time	08/03/2018 03:41:43 PM Central Daylight Time	08/03/2018 02:00:50 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage POS Rx (HMO-POS)	01	02		1			H3471	013	0	2019	Yakima County		2	874	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	014	0	1	02	01	H3471_014_0	9	1				07/26/2018	2019.01	07/26/2018 09:15:37 AM Central Daylight Time	08/03/2018 03:45:04 PM Central Daylight Time	08/03/2018 02:01:27 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage POS Rx Plus (HMO-POS)	01	02		1			H3471	014	0	2019	Yakima County		2	1456	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	015	0	1	02	01	H3471_015_0	7	1				07/26/2018	2019.01	07/26/2018 09:16:53 AM Central Daylight Time	06/02/2018 09:04:32 PM Central Daylight Time				07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage POS (HMO-POS)	01	02		1			H3471	015	0	2019	Yakima County		2	203	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	017	0	1	01	01	H3471_017_0	9	1				08/01/2018	2019.01	08/01/2018 04:30:11 PM Central Daylight Time	08/03/2018 04:39:18 PM Central Daylight Time	08/03/2018 02:02:06 PM Central Daylight Time			08/07/2018 01:30:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	healthalliancemedicare.org	Health Alliance NW Companion Basic Rx 2 (HMO)	01	01		1			H3471	017	0	2019	Grant County		2	1159	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	801	0	1	01	01	H3471_801_0	3	1				06/05/2018	2019.01	06/05/2018 09:32:24 AM Central Daylight Time					07/19/2018 02:59:02 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H3471	801	0	2019	Central Washington		1	120	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H3471	802	0	1	01	01	H3471_802_0	2	1				06/05/2018	2019.01	06/05/2018 09:32:32 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H3471	802	0	2019	Central Washington		1	1200	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H3471	803	0	1	01	01	H3471_803_0	2	1				06/05/2018	2019.01	06/05/2018 09:32:39 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO Rx - non calendar year (HMO)	01	01		1			H3471	803	0	2019	Central Washington		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H3471	804	0	1	02	01	H3471_804_0	2	1				06/05/2018	2019.01	06/05/2018 09:32:46 AM Central Daylight Time					06/05/2018 09:42:24 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS (HMO-POS)	01	02		1			H3471	804	0	2019	Central Washington		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										1	2		2		1	2		2		1				
H3471	805	0	1	02	01	H3471_805_0	3	1				06/05/2018	2019.01	06/05/2018 09:32:52 AM Central Daylight Time					07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	01	02		1			H3471	805	0	2019	Central Washington		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H3471	806	0	1	02	01	H3471_806_0	3	1				06/05/2018	2019.01	06/05/2018 09:32:58 AM Central Daylight Time					07/26/2018 09:50:35 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	01	02		1			H3471	806	0	2019	Central Washington		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)531-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H3473	001	0	1	20	08	H3473_001_0	1	1				05/31/2018	2019.01	05/31/2018 08:16:10 PM Eastern Daylight Time		05/31/2018 08:06:41 PM Eastern Daylight Time			05/31/2018 08:21:44 PM Eastern Daylight Time	CHARLOTTESVILLE AREA RETIREMENT SERVICES, INC.	Blue Ridge PACE	www.riversideonline.com	Blue Ridge PACE Dual (PACE)	08	20		1			H3473	001	0	2019	Blue Ridge PACE Dual		2		2			2						www.riversideonline.com	N/A - no formulary										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569																
H3473	002	0	1	20	08	H3473_002_0	1	1				05/31/2018	2019.01	05/31/2018 08:16:31 PM Eastern Daylight Time		05/31/2018 08:06:32 PM Eastern Daylight Time			05/31/2018 08:21:44 PM Eastern Daylight Time	CHARLOTTESVILLE AREA RETIREMENT SERVICES, INC.	Blue Ridge PACE	www.riversideonline.com	Blue Ridge PACE Medicare Only (PACE)	08	20		1			H3473	002	0	2019	Blue Ridge PACE Medicare Only		2		2			2						www.riversideonline.com	N/A - no formulary										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569																
H3493	001	0	1	20	08	H3493_001_0	1	1				05/22/2018	2019.01	05/22/2018 12:23:03 PM Eastern Daylight Time		05/22/2018 08:46:56 AM Eastern Daylight Time			05/22/2018 12:26:01 PM Eastern Daylight Time	LIFE AT LOURDES, INC.	LIFE at Lourdes	www.lourdesnet.org/programs-and-services/life-at-l	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	001	0	2019	LIFE at Lourdes		2		2			2						www.carekinesis.com	www.lourdesnet.org										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355																
H3493	002	0	1	20	08	H3493_002_0	1	1				05/22/2018	2019.01	05/22/2018 12:23:59 PM Eastern Daylight Time		05/22/2018 08:48:54 AM Eastern Daylight Time			05/22/2018 12:26:01 PM Eastern Daylight Time	LIFE AT LOURDES, INC.	LIFE at Lourdes	https://www.lourdesnet.org/programs-and-services/l	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	002	0	2019	LIFE at Lourdes		2		2			2						www.carekinesis.com	www.lourdesnet.org										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355																
H3499	001	0	1	01	01	H3499_001_0	4	1				08/02/2018	2019.01	08/02/2018 08:59:42 AM Pacific Daylight Time	08/04/2018 11:47:26 AM Pacific Daylight Time	08/04/2018 11:51:14 AM Pacific Daylight Time			08/04/2018 12:15:46 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (HMO)	01	01		1			H3499	001	0	2019	12 counties in Central Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	002	0	1	01	01	H3499_002_0	4	1				08/02/2018	2019.01	08/02/2018 08:59:59 AM Pacific Daylight Time	08/04/2018 11:53:57 AM Pacific Daylight Time	08/04/2018 11:55:13 AM Pacific Daylight Time			08/04/2018 12:15:46 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (HMO)	01	01		1			H3499	002	0	2019	Allen, Elkhart, St. Joseph, Wells, Whitley		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	003	0	1	01	01	H3499_003_0	5	1				08/02/2018	2019.01	08/02/2018 09:00:11 AM Pacific Daylight Time	08/04/2018 01:43:42 PM Pacific Daylight Time	08/04/2018 01:43:02 PM Pacific Daylight Time			08/04/2018 01:49:25 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (HMO)	01	01		1			H3499	003	0	2019	Vanderburgh, Posey, Warrick		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	004	0	1	01	01	H3499_004_0	4	1				08/01/2018	2019.01	08/01/2018 03:55:27 PM US Mountain Standard Time	08/04/2018 01:44:10 PM Pacific Daylight Time	08/04/2018 01:44:34 PM Pacific Daylight Time			08/04/2018 01:49:25 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (HMO)	01	01		1			H3499	004	0	2019	Lake, Laporte, and Porter Counties		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	005	0	1	01	01	H3499_005_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 01:35:56 PM Pacific Daylight Time	08/04/2018 01:48:46 PM Pacific Daylight Time	08/04/2018 01:45:07 PM Pacific Daylight Time			08/04/2018 01:49:25 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H3499	005	0	2019	24 counties in No., Central and So. Indiana		2		2			1	3		1		1	allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	801	0	1	01	01	H3499_801_0	1	1				05/29/2018	2019.01	05/29/2018 04:38:20 PM Pacific Daylight Time					06/03/2018 03:06:09 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H3499	801	0	2019	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.coordinatedcarehealth.com/find-doctor.html	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3499	802	0	1	01	01	H3499_802_0	1	1				05/29/2018	2019.01	05/29/2018 04:38:26 PM Pacific Daylight Time					06/03/2018 03:06:09 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H3499	802	0	2019	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.coordinatedcarehealth.com/find-doctor.html	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3499	803	0	1	01	01	H3499_803_0	1	1				05/29/2018	2019.01	05/29/2018 05:27:50 PM Pacific Daylight Time					06/03/2018 03:06:09 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H3499	803	0	2019	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.coordinatedcarehealth.com/find-doctor.html	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3517	001	0	1	20	08	H3517_001_0	2	1				06/04/2018	2019.01	06/04/2018 12:29:16 PM Pacific Daylight Time		06/04/2018 12:27:05 PM Pacific Daylight Time			06/04/2018 12:30:12 PM Pacific Daylight Time	HUMBOLDT SENIOR RESOURCE CENTER, INC.	Redwood Coast PACE	www.humsenior.org	Redwood  Coast PACE-Dual (PACE)	08	20		1			H3517	001	0	2019	Redwood Coast PACE-Dual		2		2			2						www.pharmastarpbm.com	www.pharmastarpbm.com	n/a									(707)443-9747		(707)443-9747		(707)443-9747		(707)443-9747										(711)-		(711)-		(711)-		(711)-																
H3517	002	0	1	20	08	H3517_002_0	2	1				06/04/2018	2019.01	06/04/2018 12:29:25 PM Pacific Daylight Time		06/04/2018 12:27:30 PM Pacific Daylight Time			06/04/2018 12:30:12 PM Pacific Daylight Time	HUMBOLDT SENIOR RESOURCE CENTER, INC.	Redwood Coast PACE	www.humsenior.org	Redwood Coast PACE-Medicare Only (PACE)	08	20		1			H3517	002	0	2019	Redwood Coast PACE-Medicare Only		2		2			2						www.pharmastarpbm.com	www.pharmastarpbm.com										(707)443-9747		(707)443-9747		(707)443-9747		(707)443-9747										(711)-		(711)-		(711)-		(711)-																
H3528	003	0	1	01	01	H3528_003_0	9	1				07/17/2018	2019.01	07/17/2018 11:32:53 AM Eastern Daylight Time	07/17/2018 11:05:40 AM Eastern Daylight Time				07/17/2018 11:33:23 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 2 (HMO)	01	01		1			H3528	003	0	2019	State of Connecticut		2	16417	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										2					2					2	2			
H3528	006	0	1	02	01	H3528_006_0	10	1				07/12/2018	2019.01	07/12/2018 01:22:04 PM Eastern Daylight Time	08/02/2018 04:33:16 PM Eastern Daylight Time	07/31/2018 06:06:52 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 1 (HMO-POS)	01	02		1			H3528	006	0	2019	State of Connecticut		2	5822	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	010	0	1	01	01	H3528_010_0	11	1				08/03/2018	2019.01	08/03/2018 01:36:33 PM Eastern Daylight Time	08/02/2018 04:33:55 PM Eastern Daylight Time	07/31/2018 06:08:26 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Passage Plan 1 (HMO)	01	01		1			H3528	010	0	2019	State of Connecticut		2	219592	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	2			
H3528	011	1	1	02	01	H3528_011_1	11	1				08/05/2018	2019.01	08/05/2018 12:55:02 PM Eastern Daylight Time	08/02/2018 04:34:36 PM Eastern Daylight Time	07/31/2018 06:09:30 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	01	02		1			H3528	011	1	2019	State of Connecticut	Hartford, Litchfield, Middlesex, Tolland counties	2	86481	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	011	2	1	02	01	H3528_011_2	11	1				08/03/2018	2019.01	08/03/2018 01:36:07 PM Eastern Daylight Time	08/02/2018 04:35:16 PM Eastern Daylight Time	07/31/2018 06:10:28 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	01	02		1			H3528	011	2	2019	State of Connecticut	Fairfield, New Haven, New London, Windham counties	2	114821	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	012	1	1	02	01	H3528_012_1	10	1				08/03/2018	2019.01	08/03/2018 01:35:56 PM Eastern Daylight Time	08/02/2018 04:35:57 PM Eastern Daylight Time	07/31/2018 06:11:14 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 2 (HMO-POS)	01	02		1			H3528	012	1	2019	Counties: HTFD, LIT, MID, NH, NL, TOL, WIN	Hartford, Litchfield, Middlesex, Tolland counties	2	21252	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	012	2	1	02	01	H3528_012_2	11	1				08/03/2018	2019.01	08/03/2018 01:35:41 PM Eastern Daylight Time	08/02/2018 04:36:37 PM Eastern Daylight Time	07/31/2018 06:12:06 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 2 (HMO-POS)	01	02		1			H3528	012	2	2019	Counties: HTFD, LIT, MID, NH, NL, TOL, WIN	New Haven, New London, Windham counties	2	16907	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	013	1	1	01	01	H3528_013_1	11	1				07/12/2018	2019.01	07/12/2018 01:24:30 PM Eastern Daylight Time	08/02/2018 04:37:18 PM Eastern Daylight Time	07/31/2018 06:12:56 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 1 (HMO)	01	01		1			H3528	013	1	2019	Counties: HTFD, LIT, MID, NH, NL, TOL, WIN	Hartford, Litchfield, Middlesex, Tolland counties	2	15688	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	013	2	1	01	01	H3528_013_2	11	1				07/16/2018	2019.01	07/16/2018 01:25:15 PM Eastern Daylight Time	08/02/2018 04:37:58 PM Eastern Daylight Time	07/31/2018 06:14:08 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 1 (HMO)	01	01		1			H3528	013	2	2019	Counties: HTFD, LIT, MID, NH, NL, TOL, WIN	New Haven, New London, Windham counties	2	12606	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	014	0	1	01	01	H3528_014_0	11	1				08/06/2018	2019.01	08/06/2018 10:29:32 AM Eastern Daylight Time	08/02/2018 04:38:38 PM Eastern Daylight Time	07/31/2018 06:14:56 PM Eastern Daylight Time			08/06/2018 10:36:24 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 3 (HMO)	01	01		1			H3528	014	0	2019	State of Connecticut		2	108268	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(800)224-2273		(800)224-2273		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	1	01	7a;	
H3528	801	0	1	01	01	H3528_801_0	6	1				06/02/2018	2019.01	06/02/2018 02:15:25 PM Eastern Daylight Time					06/04/2018 06:21:27 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare EGHP (HMO)	01	01		1			H3528	801	0	2019	U.S and Territories		1	4870	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1					1				
H3528	805	0	1	01	01	H3528_805_0	6	1				06/02/2018	2019.01	06/02/2018 02:15:51 PM Eastern Daylight Time					06/04/2018 06:21:27 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare EGHP (HMO)	01	01		1			H3528	805	0	2019	U.S and Territories		1	0	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										1	1	1a;1b;2;3-3;5;6;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1					1				
H3528	806	0	1	02	01	H3528_806_0	6	1				06/02/2018	2019.01	06/02/2018 02:16:20 PM Eastern Daylight Time					06/04/2018 06:21:27 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare EGHP (HMO-POS)	01	02		1			H3528	806	0	2019	U.S and Territories		1	6749	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1				
H3528	807	0	1	02	01	H3528_807_0	6	1				06/02/2018	2019.01	06/02/2018 02:16:48 PM Eastern Daylight Time					06/04/2018 06:21:27 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare EGHP (HMO-POS)	01	02		1			H3528	807	0	2019	U.S and Territories		1	0	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1				
H3533	001	0	1	01	01	H3533_001_0	4	1				07/18/2018	2019.01	07/18/2018 04:52:34 PM Eastern Daylight Time	06/01/2018 03:16:24 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-001 (HMO)	01	01		1			H3533	001	0	2019	Oneida, Onondaga and Oswego counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	002	0	1	01	01	H3533_002_0	4	1	2	1		07/02/2018	2019.01	07/02/2018 03:56:11 PM Eastern Daylight Time	06/01/2018 03:11:17 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:29 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-002 (HMO SNP)	01	01		1			H3533	002	0	2019	Select Counties in New York		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	004	0	1	01	01	H3533_004_0	3	1	2	1		07/02/2018	2019.01	07/02/2018 03:55:13 PM Eastern Daylight Time	06/01/2018 03:14:50 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-004 (HMO SNP)	01	01		1			H3533	004	0	2019	Select Counties in New York		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	006	0	1	01	01	H3533_006_0	4	1				07/18/2018	2019.01	07/18/2018 04:52:51 PM Eastern Daylight Time	06/01/2018 03:14:19 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-006 (HMO)	01	01		1			H3533	006	0	2019	Capital Region		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	010	0	1	01	01	H3533_010_0	4	1				07/18/2018	2019.01	07/18/2018 04:53:08 PM Eastern Daylight Time	06/01/2018 03:15:22 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-010 (HMO)	01	01		1			H3533	010	0	2019	Nassau and Suffolk (partial) counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	013	0	1	01	01	H3533_013_0	4	1				07/18/2018	2019.01	07/18/2018 04:53:20 PM Eastern Daylight Time	06/01/2018 03:16:55 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-013 (HMO)	01	01		1			H3533	013	0	2019	Select Counties in New York		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	020	0	1	01	01	H3533_020_0	3	1				07/02/2018	2019.01	07/02/2018 12:09:04 PM Eastern Daylight Time	06/01/2018 03:15:52 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-020 (HMO)	01	01		1			H3533	020	0	2019	Southern Tier Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	021	0	1	01	01	H3533_021_0	3	1				07/02/2018	2019.01	07/02/2018 12:09:48 PM Eastern Daylight Time	08/03/2018 05:21:13 PM Eastern Daylight Time	08/03/2018 09:21:04 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-021 (HMO)	01	01		1			H3533	021	0	2019	Select Counties in New York		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	023	0	1	01	01	H3533_023_0	4	1				07/18/2018	2019.01	07/18/2018 04:53:59 PM Eastern Daylight Time	06/01/2018 03:18:28 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-023 (HMO)	01	01		1			H3533	023	0	2019	Select Counties in New York City and Long Island		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	027	0	1	01	01	H3533_027_0	3	1				07/02/2018	2019.01	07/02/2018 12:10:17 PM Eastern Daylight Time	06/01/2018 03:19:31 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 09:55:04 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-027 (HMO)	01	01		1			H3533	027	0	2019	Select Counties in New York City and Long Island		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	802	0	1	01	01	H3533_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:32:18 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H3533	802	0	2019	Select Counties in NY		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3533	803	0	1	01	01	H3533_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:33:33 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H3533	803	0	2019	Select Counties in NY		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3536	002	0	1	01	01	H3536_002_0	6	1				08/06/2018	2019.01	08/06/2018 12:58:19 PM Eastern Daylight Time	08/06/2018 12:23:11 AM Eastern Daylight Time	08/01/2018 08:06:50 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3536	002	0	2019	Select Counties in New Hampshire		2	22159	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(844)368-4243		(844)368-4243		(855)310-2473		(855)310-2473		(844)368-4242		(844)368-4242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	004	0	1	01	01	H3536_004_0	5	1				08/03/2018	2019.01	08/03/2018 10:48:14 AM Eastern Daylight Time	08/06/2018 12:24:12 AM Eastern Daylight Time	08/01/2018 07:07:36 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H3536	004	0	2019	Select Counties in New Hampshire		2	23975	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(844)467-1557		(844)467-1557		(855)310-2473		(855)310-2473		(844)467-1558		(844)467-1558		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	005	0	1	01	01	H3536_005_0	6	1				08/03/2018	2019.01	08/03/2018 08:57:19 PM Eastern Daylight Time	08/06/2018 12:25:12 AM Eastern Daylight Time	08/01/2018 08:07:34 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H3536	005	0	2019	Select Counties in New Hampshire		2	2428	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(844)368-4243		(844)368-4243		(855)310-2473		(855)310-2473		(844)368-4242		(844)368-4242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	801	0	1	01	01	H3536_801_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:22 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		1			H3536	801	0	2019	Select counties in New Hampshire		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	802	0	1	01	01	H3536_802_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:29 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		1			H3536	802	0	2019	Select Counties in New Hampshire		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	803	0	2	01	01	H3536_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:18 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3536	803	0	2019	New Hampshire - Select Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	804	0	2	01	01	H3536_804_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:25 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3536	804	0	2019	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	805	0	1	01	01	H3536_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:51 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		1			H3536	805	0	2019	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	806	0	1	01	01	H3536_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:59 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		1			H3536	806	0	2019	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	807	0	2	01	01	H3536_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:16:57 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3536	807	0	2019	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	808	0	2	01	01	H3536_808_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:07 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3536	808	0	2019	Select NH counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3561	001	0	1	01	01	H3561_001_0	5	1	2	1		07/17/2018	2019.01	07/17/2018 07:21:54 PM Pacific Daylight Time	08/06/2018 03:14:12 PM Pacific Daylight Time	08/04/2018 10:20:14 AM Pacific Daylight Time			08/06/2018 03:25:55 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Amber II Premier (HMO SNP)	01	01		1			H3561	001	0	2019	Fresno County		2		2			1	3		2		2	ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	002	0	1	01	01	H3561_002_0	5	1				07/18/2018	2019.01	07/18/2018 10:37:28 AM Pacific Daylight Time	08/06/2018 03:14:14 PM Pacific Daylight Time	08/04/2018 10:20:14 AM Pacific Daylight Time			08/06/2018 03:25:55 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier (HMO)	01	01		1			H3561	002	0	2019	Ala, Fre, Ker, LA, Ora, SD, SF, Tul Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	004	0	1	01	01	H3561_004_0	5	1				07/18/2018	2019.01	07/18/2018 10:37:38 AM Pacific Daylight Time	08/06/2018 03:14:14 PM Pacific Daylight Time	08/04/2018 10:20:14 AM Pacific Daylight Time			08/06/2018 03:25:55 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier (HMO)	01	01		1			H3561	004	0	2019	Imperial, Riverside, San Bernardino Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	005	0	1	01	01	H3561_005_0	5	1				07/18/2018	2019.01	07/18/2018 10:37:49 AM Pacific Daylight Time	08/06/2018 03:14:14 PM Pacific Daylight Time	08/04/2018 10:20:14 AM Pacific Daylight Time			08/06/2018 03:25:55 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier II (HMO)	01	01		1			H3561	005	0	2019	Ala, Fre, Ker, LA, Ora, SD, SF, Tul Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	006	0	1	01	01	H3561_006_0	5	1				07/18/2018	2019.01	07/18/2018 10:38:01 AM Pacific Daylight Time	08/06/2018 03:14:14 PM Pacific Daylight Time	08/04/2018 10:20:16 AM Pacific Daylight Time			08/06/2018 03:25:55 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier II (HMO)	01	01		1			H3561	006	0	2019	Imperial, Riverside, San Bernardino Counties		2		2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	801	0	1	01	01	H3561_801_0	2	1				05/29/2018	2019.01	05/29/2018 04:39:00 PM Pacific Daylight Time					06/04/2018 04:19:27 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H3561	801	0	2019	California		1	100	2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3561	802	0	1	01	01	H3561_802_0	2	1				05/29/2018	2019.01	05/29/2018 05:27:56 PM Pacific Daylight Time					06/04/2018 04:19:27 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H3561	802	0	2019	California		1	100	2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3561	803	0	1	01	01	H3561_803_0	2	1				05/29/2018	2019.01	05/29/2018 04:39:06 PM Pacific Daylight Time					06/04/2018 04:19:27 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	ca.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H3561	803	0	2019	California		1	100	2			2						ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	ca.healthnetadvantage.com/prescription-drugs-formulary/formulary	ca.healthnetadvantage.com/find-doctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3572	001	0	1	01	01	H3572_001_0	4	1		1		07/02/2018	2019.01	07/02/2018 02:00:01 PM Pacific Daylight Time	08/03/2018 11:52:04 AM Pacific Daylight Time	08/03/2018 11:52:04 AM Pacific Daylight Time			08/03/2018 11:54:43 AM Pacific Daylight Time	AHF MCO OF GEORGIA, INC.	AHF	www.php-ga.org	PHP (HMO SNP)	01	01		1			H3572	001	0	2019	Fulton County, Georgia		2		2			1	4			00000000001000000000		www.php-ga.org/provider-find	www.php-ga.org/for-members/drug-benefit/formulary	www.php-ga.org/provider-find	(833)267-6768		(833)267-6768		(833)267-6768		(833)267-6768		(833)267-6769		(833)267-6769		(833)267-6768		(833)267-6768		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	001	0	1	01	01	H3597_001_0	4	1				08/01/2018	2019.01	08/01/2018 04:01:43 PM Eastern Daylight Time	08/03/2018 10:12:21 AM Central Daylight Time	07/31/2018 10:02:10 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	001	0	2019	Southern Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	007	0	1	01	01	H3597_007_0	3	1				08/01/2018	2019.01	08/01/2018 04:02:34 PM Eastern Daylight Time	08/03/2018 10:13:02 AM Central Daylight Time	07/31/2018 10:03:24 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	007	0	2019	Mid Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	009	0	1	01	01	H3597_009_0	3	1				07/11/2018	2019.01	07/11/2018 02:49:57 PM Central Daylight Time	08/03/2018 10:13:45 AM Central Daylight Time	07/31/2018 10:04:26 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	009	0	2019	Northern and Additional Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	801	0	1	01	01	H3597_801_0	2	1				06/04/2018	2019.01	06/04/2018 10:54:35 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3597	801	0	2019	Maine		1	250	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3597	802	0	1	01	01	H3597_802_0	2	1				06/04/2018	2019.01	06/04/2018 10:54:48 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3597	802	0	2019	Maine		1	150	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	http://www.aetnamedicaredocfind.com/	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3613	001	0	1	20	08	H3613_001_0	1	1				05/22/2018	2019.01	05/22/2018 07:53:10 AM Eastern Daylight Time		05/22/2018 07:45:28 AM Eastern Daylight Time			05/22/2018 08:00:47 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Dual Eligibles (PACE)	08	20		1			H3613	001	0	2019	McGregor PACE Cuyahoga County		2		2			2						http://www.catamaranrx.com/	http://www.catamaranrx.com/										(216)791-3580		(216)791-3580		(216)791-3580		(216)791-3580										(800)325-2223		(800)325-2223		(800)325-2223		(800)325-2223																
H3613	002	0	1	20	08	H3613_002_0	1	1				05/22/2018	2019.01	05/22/2018 07:53:35 AM Eastern Daylight Time		05/22/2018 07:45:34 AM Eastern Daylight Time			05/22/2018 08:00:47 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Medicare Only Eligibles (PACE)	08	20		1			H3613	002	0	2019	McGregor PACE Cuyahoga County		2		2			2						http://www.catamaranrx.com/	http://www.catamaranrx.com/										(216)791-3580		(216)791-3580		(216)202-1650		(216)202-1650										(800)325-2223		(800)325-2223		(800)325-2223		(800)325-2223																
H3653	004	0	1	01	01	H3653_004_0	6	1				06/29/2018	2019.01	06/29/2018 09:41:03 AM Eastern Daylight Time	08/03/2018 01:42:56 PM Eastern Daylight Time	08/03/2018 01:42:57 PM Eastern Daylight Time			08/03/2018 01:44:36 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical and Drug (HMO)	01	01		1			H3653	004	0	2019	Paramount Elite - Enhanced (Northern OH / SE Mich)		2	145207	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		2					2					2	2			
H3653	015	0	1	01	01	H3653_015_0	6	1				06/29/2018	2019.01	06/29/2018 09:42:22 AM Eastern Daylight Time	08/03/2018 01:42:59 PM Eastern Daylight Time	08/03/2018 01:43:00 PM Eastern Daylight Time			08/03/2018 01:44:36 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Standard Medical and Drug (HMO)	01	01		1			H3653	015	0	2019	Paramount Elite - Standard (Northern OH / SE Mich)		2	40279	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		2					2					2	2			
H3653	018	0	1	01	01	H3653_018_0	6	1				06/29/2018	2019.01	06/29/2018 09:43:18 AM Eastern Daylight Time	07/13/2018 02:54:47 PM Eastern Daylight Time				07/13/2018 02:56:09 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical Only (HMO)	01	01		1			H3653	018	0	2019	Paramount Elite - Medical Only (North OH/ SE Mich)		2	1560	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										2					2					2	2			
H3653	022	0	1	01	01	H3653_022_0	6	1				06/29/2018	2019.01	06/29/2018 09:44:19 AM Eastern Daylight Time	08/03/2018 01:43:02 PM Eastern Daylight Time	08/03/2018 01:43:04 PM Eastern Daylight Time			08/03/2018 01:44:36 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Prime Medical and Drug (HMO)	01	01		1			H3653	022	0	2019	Paramount Elite - Prime (Northern OH / SE Mich)		2	36105	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		2					2					2	2			
H3653	803	0	1	01	01	H3653_803_0	1	1				05/24/2018	2019.01	05/24/2018 12:01:29 PM Eastern Daylight Time					05/25/2018 04:18:44 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group A/B No Rx (HMO)	01	01		1			H3653	803	0	2019	Paramount Elite - Emp Group A/B No Rx		1	14208	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										1	1	1a;1b;2;5;6;7h;8b1;9a1;9b;11a;11b;15;	2		1					1				
H3653	806	0	2	01	01	H3653_806_0	1	1				05/24/2018	2019.01	05/24/2018 12:27:38 PM Eastern Daylight Time					05/25/2018 04:18:44 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group B Only No Rx (HMO)	01	01		2	2		H3653	806	0	2019	Paramount Elite - Emp Group B Only No Rx		1	960	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										1	1	1a;1b;2;5;6;7h;8b1;9a1;9b;11a;11b;15;	2		1					1				
H3653	809	0	1	01	01	H3653_809_0	1	1				05/24/2018	2019.01	05/24/2018 12:17:55 PM Eastern Daylight Time					05/25/2018 04:18:44 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite-Emp Group A/B Rx (HMO)	01	01		1			H3653	809	0	2019	Paramount Elite-Emp Group A/B Rx		1	780	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		1	1	1a;1b;2;5;6;7h;8b1;9a1;9b;11a;11b;15;	2		1					1				
H3655	032	0	1	01	01	H3655_032_0	7	1				08/03/2018	2019.01	08/03/2018 10:41:15 AM Eastern Daylight Time	08/06/2018 12:26:13 AM Eastern Daylight Time	08/01/2018 08:08:20 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Essential (HMO)	01	01		1			H3655	032	0	2019	Select Counties in Ohio		2	1722024	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	033	0	1	01	01	H3655_033_0	10	1	2	1		08/03/2018	2019.01	08/03/2018 10:42:25 AM Eastern Daylight Time	08/06/2018 12:27:15 AM Eastern Daylight Time	08/01/2018 07:09:32 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H3655	033	0	2019	Select Counties in Ohio		2	225804	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(844)879-3610		(844)879-3610		(844)467-1561		(844)467-1561		(844)879-3610		(844)879-3610		(844)467-1562		(844)467-1562		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	034	0	1	01	01	H3655_034_0	7	1				07/20/2018	2019.01	07/20/2018 01:41:08 PM Eastern Daylight Time	08/06/2018 12:28:16 AM Eastern Daylight Time	08/01/2018 08:09:04 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3655	034	0	2019	Select Counties in Ohio		2	43644	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	038	0	1	01	01	H3655_038_0	11	1				08/03/2018	2019.01	08/03/2018 10:42:55 AM Eastern Daylight Time	08/06/2018 12:29:16 AM Eastern Daylight Time	08/01/2018 08:09:48 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Prime Select (HMO)	01	01		1			H3655	038	0	2019	Select Counties in Ohio		2	14328	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	040	0	1	01	01	H3655_040_0	11	1				08/03/2018	2019.01	08/03/2018 10:43:19 AM Eastern Daylight Time	08/06/2018 12:30:17 AM Eastern Daylight Time	08/01/2018 08:10:35 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Preferred (HMO)	01	01		1			H3655	040	0	2019	Select Counties in Ohio		2	342780	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	041	0	1	01	01	H3655_041_0	11	1				08/03/2018	2019.01	08/03/2018 10:44:21 AM Eastern Daylight Time	08/06/2018 12:31:19 AM Eastern Daylight Time	08/01/2018 08:11:20 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3655	041	0	2019	Select Counties in Ohio		2	19860	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	801	0	1	01	01	H3655_801_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:48 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	801	0	2019	Ohio		1	4223	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	803	0	1	01	01	H3655_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:54 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	803	0	2019	Ohio		1	4223	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	805	0	2	01	01	H3655_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:01 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H3655	805	0	2019	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	806	0	2	01	01	H3655_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:11 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H3655	806	0	2019	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	807	0	1	01	01	H3655_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:43 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	807	0	2019	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	808	0	1	01	01	H3655_808_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:51 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	808	0	2019	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	809	0	2	01	01	H3655_809_0	2	1				06/19/2018	2019.01	06/19/2018 01:20:00 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H3655	809	0	2019	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	810	0	2	01	01	H3655_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:20:09 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H3655	810	0	2019	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3660	028	0	1	02	01	H3660_028_0	10	1				08/06/2018	2019.01	08/06/2018 04:30:49 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time			08/07/2018 02:00:09 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Emerald (HMO-POS)	01	02		1			H3660	028	0	2019	Northeast Ohio		2	19163	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	029	0	1	02	01	H3660_029_0	10	1				08/06/2018	2019.01	08/06/2018 04:31:20 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time			08/07/2018 02:00:09 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	01	02		1			H3660	029	0	2019	Northeast Ohio		2	67391	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	044	0	1	01	01	H3660_044_0	10	1				08/06/2018	2019.01	08/06/2018 04:29:47 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time			08/07/2018 02:00:09 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	044	0	2019	Northeast Ohio		2	78238	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	047	0	1	01	01	H3660_047_0	9	1				08/06/2018	2019.01	08/06/2018 04:30:22 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time			08/07/2018 02:00:09 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	047	0	2019	Northwest Ohio		2	12512	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	048	0	1	02	01	H3660_048_0	8	1				08/06/2018	2019.01	08/06/2018 04:31:36 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time	08/07/2018 01:56:12 PM Eastern Daylight Time			08/07/2018 02:00:09 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	01	02		1			H3660	048	0	2019	Northwest Ohio		2	1359	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	050	0	1	01	01	H3660_050_0	12	1				08/06/2018	2019.01	08/06/2018 04:31:54 PM Eastern Daylight Time	08/07/2018 03:15:24 PM Eastern Daylight Time	08/07/2018 03:15:26 PM Eastern Daylight Time			08/07/2018 03:18:34 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	01	01		1			H3660	050	0	2019	Northeast Ohio		2	106398	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	801	0	1	01	01	H3660_801_0	4	1				06/05/2018	2019.01	06/05/2018 11:25:30 AM Eastern Daylight Time					06/05/2018 11:30:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan with Part D (HMO)	01	01		1			H3660	801	0	2019	Nationwide Service Area		1	2170	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		2					1				
H3660	802	0	1	01	01	H3660_802_0	4	1				06/05/2018	2019.01	06/05/2018 11:27:09 AM Eastern Daylight Time					06/05/2018 11:30:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO)	01	01		1			H3660	802	0	2019	Nationwide Service Area		1	90	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440										(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750										1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		2					1				
H3660	805	0	1	02	01	H3660_805_0	4	1				06/05/2018	2019.01	06/05/2018 11:26:18 AM Eastern Daylight Time					06/05/2018 11:30:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan with Part D (HMO-POS)	01	02		1			H3660	805	0	2019	Nationwide Service Area		1	3056	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		2				
H3660	806	0	1	02	01	H3660_806_0	4	1				06/05/2018	2019.01	06/05/2018 11:26:31 AM Eastern Daylight Time					06/05/2018 11:30:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO-POS)	01	02		1			H3660	806	0	2019	Nationwide Service Area		1	57	2			2						www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440										(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750										1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H3664	014	0	1	02	01	H3664_014_0	4	1				08/03/2018	2019.01	08/03/2018 06:30:19 PM Eastern Daylight Time	06/01/2018 03:15:08 PM Eastern Daylight Time				08/03/2018 06:30:53 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Basic - MA Only (HMO-POS)	01	02		1			H3664	014	0	2019	Operating in 12 counties in Northeastern Ohio		2		2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										2					2					2	2			
H3664	017	0	1	02	01	H3664_017_0	4	1				07/30/2018	2019.01	07/30/2018 04:34:50 PM Eastern Daylight Time	08/03/2018 12:58:10 PM Eastern Daylight Time	08/03/2018 12:58:10 PM Eastern Daylight Time			08/03/2018 01:04:01 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Plus (HMO-POS)	01	02		1			H3664	017	0	2019	Operating in 12 counties in Northeastern Ohio		2		2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2	2			
H3664	020	0	1	02	01	H3664_020_0	4	1				07/30/2018	2019.01	07/30/2018 04:35:04 PM Eastern Daylight Time	08/03/2018 12:58:11 PM Eastern Daylight Time	08/03/2018 12:58:09 PM Eastern Daylight Time			08/03/2018 01:04:01 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Classic (HMO-POS)	01	02		1			H3664	020	0	2019	Operating in 12 counties in Northeastern Ohio		2		2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2	2			
H3664	021	0	1	02	01	H3664_021_0	4	1				07/30/2018	2019.01	07/30/2018 04:35:21 PM Eastern Daylight Time	08/03/2018 12:58:09 PM Eastern Daylight Time	08/03/2018 12:58:10 PM Eastern Daylight Time			08/03/2018 01:04:01 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Aultimate (HMO-POS)	01	02		1			H3664	021	0	2019	Operating in 12 counties in Northeastern Ohio		2		2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2	2			
H3664	801	0	1	02	01	H3664_801_0	2	1				07/13/2018	2019.01	07/13/2018 01:19:26 PM Eastern Daylight Time					07/26/2018 03:16:12 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO  - CY (HMO-POS)	01	02		1			H3664	801	0	2019	National Service Area		1	7152	2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	802	0	1	02	01	H3664_802_0	2	1				07/13/2018	2019.01	07/13/2018 01:19:23 PM Eastern Daylight Time					07/26/2018 03:16:12 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO MA-Only (HMO-POS)	01	02		1			H3664	802	0	2019	National Service Area		1	900	2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	803	0	1	02	01	H3664_803_0	2	1				07/13/2018	2019.01	07/13/2018 01:19:36 PM Eastern Daylight Time					07/26/2018 03:16:12 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group - Non CY (HMO-POS)	01	02		1			H3664	803	0	2019	National Service Area		1	0	2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	805	0	2	02	01	H3664_805_0	2	1				07/13/2018	2019.01	07/13/2018 01:22:55 PM Eastern Daylight Time					07/26/2018 03:16:12 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	Part B Only MA-PD (HMO-POS)	01	02		2	2		H3664	805	0	2019	Part B Only MA-PD National Service Area		1	0	2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	806	0	2	02	01	H3664_806_0	2	1				07/13/2018	2019.01	07/13/2018 01:23:05 PM Eastern Daylight Time					07/26/2018 03:16:12 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	Part B Only MA (HMO-POS)	01	02		2	2		H3664	806	0	2019	Part B Only MA National Service Area		1	0	2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	807	0	1	02	01	H3664_807_0	2	1				07/26/2018	2019.01	07/26/2018 02:16:43 PM Eastern Daylight Time					07/26/2018 03:16:12 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO - CY (HMO-POS)	01	02		1			H3664	807	0	2019	National Service Area		1	67680	2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3668	013	0	1	01	01	H3668_013_0	4	1				07/16/2018	2019.01	07/16/2018 04:07:15 PM Eastern Daylight Time	06/04/2018 02:42:12 PM Eastern Daylight Time				07/16/2018 05:14:12 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Medical Only (HMO)	01	01		1			H3668	013	0	2019	Central, Southeast and Southwest OH		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3668	014	0	1	01	01	H3668_014_0	5	1				07/16/2018	2019.01	07/16/2018 04:22:35 PM Eastern Daylight Time	08/03/2018 12:33:12 PM Eastern Daylight Time	08/03/2018 12:51:05 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southeast OH Classic Preferred (HMO)	01	01		1			H3668	014	0	2019	Southeast Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	015	0	1	01	01	H3668_015_0	5	1				07/16/2018	2019.01	07/16/2018 04:17:56 PM Eastern Daylight Time	08/03/2018 12:34:10 PM Eastern Daylight Time	08/03/2018 12:51:47 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southeast OH Essential Care (HMO)	01	01		1			H3668	015	0	2019	Southeast Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	016	0	1	01	01	H3668_016_0	5	1				07/16/2018	2019.01	07/16/2018 04:18:22 PM Eastern Daylight Time	08/03/2018 12:35:03 PM Eastern Daylight Time	08/03/2018 12:52:30 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southwest OH Classic Preferred (HMO)	01	01		1			H3668	016	0	2019	Greater Cincinnati and Champaign County Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	017	0	1	01	01	H3668_017_0	5	1				07/16/2018	2019.01	07/16/2018 04:19:38 PM Eastern Daylight Time	08/03/2018 12:35:58 PM Eastern Daylight Time	08/03/2018 12:53:10 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southwest OH Essential Care (HMO)	01	01		1			H3668	017	0	2019	Greater Cincinnati and Champaign County Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	018	1	1	01	01	H3668_018_1	5	1				07/16/2018	2019.01	07/16/2018 04:20:03 PM Eastern Daylight Time	08/03/2018 12:41:25 PM Eastern Daylight Time	08/03/2018 12:53:55 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	018	1	2019	Greater Central Ohio	Greater Columbus Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	018	2	1	01	01	H3668_018_2	5	1				07/16/2018	2019.01	07/16/2018 04:20:27 PM Eastern Daylight Time	08/03/2018 12:42:21 PM Eastern Daylight Time	08/03/2018 12:54:39 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	018	2	2019	Greater Central Ohio	Greater Dayton Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	018	3	1	01	01	H3668_018_3	5	1				07/16/2018	2019.01	07/16/2018 04:20:50 PM Eastern Daylight Time	08/03/2018 12:43:16 PM Eastern Daylight Time	08/03/2018 12:55:22 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	018	3	2019	Greater Central Ohio	South Central Ohio Area	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	019	1	1	01	01	H3668_019_1	5	1				07/16/2018	2019.01	07/16/2018 04:21:31 PM Eastern Daylight Time	08/03/2018 12:44:10 PM Eastern Daylight Time	08/03/2018 12:56:05 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	019	1	2019	Greater Central Ohio	Greater Columbus Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	019	2	1	01	01	H3668_019_2	5	1				07/16/2018	2019.01	07/16/2018 04:21:53 PM Eastern Daylight Time	08/03/2018 12:45:05 PM Eastern Daylight Time	08/03/2018 12:56:47 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	019	2	2019	Greater Central Ohio	Greater Dayton Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	019	3	1	01	01	H3668_019_3	6	1				07/16/2018	2019.01	07/16/2018 04:22:15 PM Eastern Daylight Time	08/03/2018 12:45:59 PM Eastern Daylight Time	08/03/2018 12:57:28 PM Eastern Daylight Time			08/03/2018 03:53:16 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	019	3	2019	Greater Central Ohio	Southern Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	801	0	1	01	01	H3668_801_0	1	1				05/30/2018	2019.01	05/30/2018 09:31:49 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Medical Only (HMO)	01	01		1			H3668	801	0	2019	Central, Southeast and Southwest OH		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	802	0	1	01	01	H3668_802_0	1	1				05/30/2018	2019.01	05/30/2018 09:35:02 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	802	0	2019	Central, Southeast and Southwest OH		1	6684	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	803	0	1	01	01	H3668_803_0	1	1				05/30/2018	2019.01	05/30/2018 09:38:03 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Custom (HMO)	01	01		1			H3668	803	0	2019	Central, Southeast and Southwest OH		1	2964	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	804	0	1	01	01	H3668_804_0	1	1				05/30/2018	2019.01	05/30/2018 09:38:27 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	804	0	2019	Central, Southeast and Southwest OH		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	805	0	1	01	01	H3668_805_0	1	1				05/30/2018	2019.01	05/30/2018 09:38:39 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Medical Only (HMO)	01	01		1			H3668	805	0	2019	Southeast Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	806	0	1	01	01	H3668_806_0	1	1				05/30/2018	2019.01	05/30/2018 09:38:50 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Classic (HMO)	01	01		1			H3668	806	0	2019	Southeast Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	807	0	1	01	01	H3668_807_0	1	1				05/30/2018	2019.01	05/30/2018 09:39:01 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Custom (HMO)	01	01		1			H3668	807	0	2019	Southeast Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	808	0	1	01	01	H3668_808_0	1	1				05/30/2018	2019.01	05/30/2018 09:32:44 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Medical Only (HMO)	01	01		1			H3668	808	0	2019	Southwest Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	809	0	1	01	01	H3668_809_0	1	1				05/30/2018	2019.01	05/30/2018 09:32:47 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Classic (HMO)	01	01		1			H3668	809	0	2019	Southwest Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3668	810	0	1	01	01	H3668_810_0	1	1				05/30/2018	2019.01	05/30/2018 09:39:17 AM Eastern Daylight Time					06/01/2018 01:37:05 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Custom (HMO)	01	01		1			H3668	810	0	2019	Southwest Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;	2		1					1				
H3672	013	0	1	01	01	H3672_013_0	5	1				06/18/2018	2019.01	06/18/2018 05:41:23 PM Eastern Daylight Time	08/02/2018 12:30:06 PM Eastern Daylight Time	07/31/2018 04:47:20 PM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option II (HMO)	01	01		1			H3672	013	0	2019	East Central Ohio		2	33000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	014	0	1	01	01	H3672_014_0	3	1				06/02/2018	2019.01	06/02/2018 11:40:43 AM Eastern Daylight Time	07/12/2018 12:32:15 PM Eastern Daylight Time				07/20/2018 11:05:06 AM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option I, MA Only (HMO)	01	01		1			H3672	014	0	2019	East Central Ohio		2	6000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3672	018	0	1	01	01	H3672_018_0	4	1				06/01/2018	2019.01	06/01/2018 09:46:08 AM Eastern Daylight Time	08/02/2018 12:32:01 PM Eastern Daylight Time	07/31/2018 04:48:14 PM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option IV (HMO)	01	01		1			H3672	018	0	2019	East Central Ohio		2	30000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	019	0	1	01	01	H3672_019_0	5	1	2	1		06/19/2018	2019.01	06/19/2018 11:21:20 AM Eastern Daylight Time	08/02/2018 12:36:17 PM Eastern Daylight Time	07/31/2018 04:48:54 PM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare SNP (HMO SNP)	01	01		1			H3672	019	0	2019	Southeastern Ohio, West Virginia		2	8000	2			1	3		2		2	www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	020	0	1	01	01	H3672_020_0	4	1				06/01/2018	2019.01	06/01/2018 09:47:35 AM Eastern Daylight Time	08/02/2018 12:38:16 PM Eastern Daylight Time	07/31/2018 04:49:32 PM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option II (HMO)	01	01		1			H3672	020	0	2019	Southeastern OH, West Virginia		2	75000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	021	0	1	01	01	H3672_021_0	3	1				05/31/2018	2019.01	05/31/2018 02:17:21 PM Eastern Daylight Time	07/12/2018 12:44:50 PM Eastern Daylight Time				07/20/2018 11:05:06 AM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option I, MA Only (HMO)	01	01		1			H3672	021	0	2019	Southeastern OH, West Virginia		2	6000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3672	023	0	1	01	01	H3672_023_0	4	1				06/01/2018	2019.01	06/01/2018 09:48:28 AM Eastern Daylight Time	08/02/2018 12:40:01 PM Eastern Daylight Time	07/31/2018 04:50:12 PM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare Capitol Plan (HMO)	01	01		1			H3672	023	0	2019	Kanawha and Surrounding Counties		2	2000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	024	0	1	01	01	H3672_024_0	3	1				05/31/2018	2019.01	05/31/2018 02:20:14 PM Eastern Daylight Time	07/12/2018 12:54:07 PM Eastern Daylight Time				07/20/2018 11:05:06 AM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare Capitol Plan, MA Only (HMO)	01	01		1			H3672	024	0	2019	Kanawha and Surrounding Counties		2	100	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3672	805	0	1	01	01	H3672_805_0	3	1				05/31/2018	2019.01	05/31/2018 01:15:15 PM Eastern Daylight Time					06/04/2018 12:32:45 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Employer (HMO)	01	01		1			H3672	805	0	2019	East Ohio and West Virginia, National		1	12000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	001	0	1	01	01	H3706_001_0	8	1				08/07/2018	2019.01	08/07/2018 09:26:17 AM Central Daylight Time	08/03/2018 05:43:01 PM Central Daylight Time	08/06/2018 03:57:59 PM Central Daylight Time			08/07/2018 09:29:03 AM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Classic (HMO)	01	01		1			H3706	001	0	2019	Oklahoma (Partial)		2	122676	2			2						www.GlobalHealth.com/provider-search	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(866)494-3927		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	009	0	1	01	01	H3706_009_0	5	1				07/12/2018	2019.01	07/12/2018 01:54:37 PM Central Daylight Time	06/04/2018 10:11:14 AM Central Daylight Time				07/12/2018 01:59:29 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Value (HMO)	01	01		1			H3706	009	0	2019	Oklahoma (Partial)		2	3396	2			2						www.GlobalHealth.com/provider-search	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3706	018	0	1	01	01	H3706_018_0	8	1				08/07/2018	2019.01	08/07/2018 09:26:48 AM Central Daylight Time	08/03/2018 05:41:33 PM Central Daylight Time	08/06/2018 03:59:23 PM Central Daylight Time			08/07/2018 09:29:03 AM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Select (HMO)	01	01		1			H3706	018	0	2019	Oklahoma (Partial)		2	30468	2			2						www.GlobalHhealth.com/provider-search	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(866)494-3927		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	803	0	1	01	01	H3706_803_0	4	1				05/30/2018	2019.01	05/30/2018 02:32:13 PM Central Daylight Time					06/04/2018 04:34:32 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations EGHP CY (HMO)	01	01		1			H3706	803	0	2019	Oklahoma (Partial)		1	23136	2			2						www.GlobalHealth.com/provider-search	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(866)494-3927		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e3;14e5;14e6;15;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;14e5;14e6;16b;18a;	2					2				
H3706	804	0	1	01	01	H3706_804_0	4	1				04/27/2018	2019.01	04/27/2018 01:33:17 PM Central Daylight Time					06/04/2018 04:34:32 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations EGHP Non CY (HMO)	01	01		1			H3706	804	0	2019	Oklahoma (Partial)		1	0	2			2						www.GlobalHealth.com/provider-search	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e3;14e5;14e6;15;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;14e5;14e6;18a;	2					2				
H3706	807	0	1	01	01	H3706_807_0	4	1				04/27/2018	2019.01	04/27/2018 01:33:56 PM Central Daylight Time					06/04/2018 04:34:32 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations EGHP MA only (HMO)	01	01		1			H3706	807	0	2019	Oklahoma (Partial)		1	0	2			2						www.GlobalHealth.com/provider-search	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e3;14e5;14e6;15;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;14e5;14e6;18a;	2					2				
H3708	001	0	1	01	01	H3708_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 04:01:59 PM Central Daylight Time	08/03/2018 04:08:00 PM Central Daylight Time	08/03/2018 04:08:28 PM Central Daylight Time			08/03/2018 04:13:17 PM Central Daylight Time	OKLAHOMA SUPERIOR SELECT, INC.	American Health Advantage of Oklahoma	www.tributehealthplans.com	American Health Advantage of Oklahoma (HMO SNP)	01	01		1			H3708	001	0	2019	Central and East Oklahoma		2	7714	2			1	1	3				www.tributehealthplans.com	www.tributehealthplans.com	www.tributehealthplans.com	(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H3749	001	0	1	01	01	H3749_001_0	2	1				05/25/2018	2019.01	05/25/2018 12:56:49 PM Central Daylight Time	08/03/2018 10:27:45 AM Central Daylight Time	07/31/2018 06:58:50 PM Central Daylight Time			08/06/2018 09:17:52 AM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H3749	001	0	2019	Oklahoma City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	017	0	1	01	01	H3749_017_0	2	1				06/02/2018	2019.01	06/02/2018 11:47:35 AM Central Daylight Time	08/03/2018 10:28:16 AM Central Daylight Time	07/31/2018 06:59:12 PM Central Daylight Time			08/06/2018 09:17:52 AM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H3749	017	0	2019	Tulsa Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	018	0	1	01	01	H3749_018_0	2	1				08/02/2018	2019.01	08/02/2018 01:03:27 PM Central Daylight Time	08/03/2018 10:28:46 AM Central Daylight Time	07/31/2018 06:59:36 PM Central Daylight Time			08/06/2018 09:17:52 AM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H3749	018	0	2019	Oklahoma City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	020	0	1	01	01	H3749_020_0	6	1				08/13/2018	2019.01	08/13/2018 10:05:30 AM Central Daylight Time	08/13/2018 09:37:06 AM Central Daylight Time	07/31/2018 06:59:58 PM Central Daylight Time			08/13/2018 10:54:19 AM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H3749	020	0	2019	Tulsa Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	801	0	1	01	01	H3749_801_0	1	1				05/25/2018	2019.01	05/25/2018 04:21:29 PM Central Daylight Time					06/02/2018 12:36:20 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	801	0	2019	OK Employer Sponsored Plan Service Area		1	612	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H3749	803	0	1	01	01	H3749_803_0	1	1				05/25/2018	2019.01	05/25/2018 04:21:50 PM Central Daylight Time					06/02/2018 12:36:20 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	803	0	2019	OK Employer Sponsored Plan Service Area		1	7680	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H3749	804	0	1	01	01	H3749_804_0	1	1				05/25/2018	2019.01	05/25/2018 04:22:19 PM Central Daylight Time					06/02/2018 12:36:20 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	804	0	2019	OK Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H3755	001	0	1	01	01	H3755_001_0	7	1				07/11/2018	2019.01	07/11/2018 10:59:42 AM Eastern Daylight Time	08/02/2018 01:28:00 PM Eastern Daylight Time	08/02/2018 10:19:13 AM Eastern Daylight Time			08/07/2018 02:11:25 PM Eastern Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum (HMO)	01	01		1			H3755	001	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		2		2			2						http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	http://www.ccok.com/rxformulary?Switch=2	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H3755	002	0	1	01	01	H3755_002_0	5	1				07/11/2018	2019.01	07/11/2018 10:59:50 AM Eastern Daylight Time	06/04/2018 04:00:31 PM Eastern Daylight Time				07/11/2018 05:32:59 PM Eastern Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver (HMO)	01	01		1			H3755	002	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		2		2			2						http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	http://www.ccok.com/rxformulary?Switch=2	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323										(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353										2					2					2	2			
H3755	004	0	1	01	01	H3755_004_0	7	1				07/11/2018	2019.01	07/11/2018 10:59:58 AM Eastern Daylight Time	08/02/2018 01:29:32 PM Eastern Daylight Time	08/02/2018 10:20:06 AM Eastern Daylight Time			08/07/2018 02:11:25 PM Eastern Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum Plus (HMO)	01	01		1			H3755	004	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		2		2			2						http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	http://www.ccok.com/rxformulary?Switch=2	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(877)293-8628		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H3755	005	0	1	01	01	H3755_005_0	6	1				06/03/2018	2019.01	06/03/2018 12:09:33 PM Eastern Daylight Time	08/02/2018 01:31:05 PM Eastern Daylight Time	08/02/2018 10:20:59 AM Eastern Daylight Time			08/07/2018 02:11:25 PM Eastern Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver Plus (HMO)	01	01		1			H3755	005	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		2		2			2						http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	http://www.ccok.com/rxformulary?Switch=2	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H3755	801	0	1	01	01	H3755_801_0	4	1				06/03/2018	2019.01	06/03/2018 03:26:16 PM Eastern Daylight Time					06/04/2018 04:52:32 PM Eastern Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health EGHP+D (HMO)	01	01		1			H3755	801	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		1	18960	2			2						http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	http://www.ccok.com/rxformulary?Switch=2	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;10a;11a;11b;12;14a;14d;14e2;14e6;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;12;14a;14d;14e2;16b;	1					1				
H3794	002	0	1	01	01	H3794_002_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 05:53:31 PM Central Daylight Time	08/03/2018 10:33:34 AM Central Daylight Time	07/31/2018 07:00:22 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO SNP)	01	01		1			H3794	002	0	2019	Select Counties in Wisconsin		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	001	0	1	01	01	H3805_001_0	4	1				07/12/2018	2019.01	07/12/2018 01:02:10 PM Central Daylight Time	08/03/2018 10:11:47 AM Central Daylight Time	07/31/2018 07:00:44 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	001	0	2019	Select counties in Western Oregon		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	007	0	1	01	01	H3805_007_0	3	1				07/12/2018	2019.01	07/12/2018 01:03:33 PM Central Daylight Time	08/03/2018 10:12:24 AM Central Daylight Time	07/31/2018 07:01:12 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	007	0	2019	Benton, Lane, and Linn counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	012	0	1	01	01	H3805_012_0	3	1				08/02/2018	2019.01	08/02/2018 02:47:44 PM Central Daylight Time	08/03/2018 10:13:01 AM Central Daylight Time	07/31/2018 07:01:34 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	012	0	2019	Select counties in Western Oregon		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	013	0	1	01	01	H3805_013_0	3	1				08/02/2018	2019.01	08/02/2018 02:48:04 PM Central Daylight Time	08/03/2018 10:13:38 AM Central Daylight Time	07/31/2018 07:01:58 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	013	0	2019	Benton, Lane, and Linn counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	014	0	1	01	01	H3805_014_0	3	1				07/12/2018	2019.01	07/12/2018 01:04:27 PM Central Daylight Time	08/03/2018 10:14:16 AM Central Daylight Time	07/31/2018 07:02:20 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	014	0	2019	Select counties in western Washington		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	015	0	1	01	01	H3805_015_0	3	1				07/12/2018	2019.01	07/12/2018 01:04:46 PM Central Daylight Time	08/03/2018 10:14:54 AM Central Daylight Time	07/31/2018 07:02:44 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H3805	015	0	2019	Select counties in Western Washington		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	016	0	1	01	01	H3805_016_0	3	1				08/02/2018	2019.01	08/02/2018 02:49:22 PM Central Daylight Time	08/03/2018 10:15:32 AM Central Daylight Time	07/31/2018 07:03:06 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	016	0	2019	Clark and Cowlitz counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	017	0	1	01	01	H3805_017_0	3	1				08/03/2018	2019.01	08/03/2018 07:47:29 AM Central Daylight Time	08/03/2018 10:16:11 AM Central Daylight Time	07/31/2018 07:03:30 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	017	0	2019	King county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	018	0	1	01	01	H3805_018_0	3	1				08/02/2018	2019.01	08/02/2018 02:50:02 PM Central Daylight Time	08/03/2018 10:16:49 AM Central Daylight Time	07/31/2018 07:03:56 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	018	0	2019	Thurston and Lewis Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	019	0	1	01	01	H3805_019_0	3	1				07/12/2018	2019.01	07/12/2018 01:05:55 PM Central Daylight Time	08/03/2018 10:17:26 AM Central Daylight Time	07/31/2018 07:04:18 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	019	0	2019	Kitsap and Pierce Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	020	0	1	01	01	H3805_020_0	3	1				08/02/2018	2019.01	08/02/2018 02:50:21 PM Central Daylight Time	08/03/2018 10:18:03 AM Central Daylight Time	07/31/2018 07:04:42 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	020	0	2019	Snohomish county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	021	0	1	01	01	H3805_021_0	4	1				07/12/2018	2019.01	07/12/2018 01:06:37 PM Central Daylight Time	08/03/2018 10:18:39 AM Central Daylight Time	07/31/2018 07:05:04 PM Central Daylight Time			08/06/2018 09:11:07 AM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H3805	021	0	2019	Skagit and Whatcom Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	801	0	1	01	01	H3805_801_0	1	1				05/23/2018	2019.01	05/23/2018 10:19:06 AM Central Daylight Time					06/02/2018 12:38:39 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	801	0	2019	OR Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	803	0	1	01	01	H3805_803_0	1	1				05/23/2018	2019.01	05/23/2018 10:20:55 AM Central Daylight Time					06/02/2018 12:38:39 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	803	0	2019	OR Employer Sponsored Plan Service Area		1	2436	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	804	0	1	01	01	H3805_804_0	1	1				05/23/2018	2019.01	05/23/2018 10:28:44 AM Central Daylight Time					06/02/2018 12:38:39 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	804	0	2019	OR Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	805	0	1	01	01	H3805_805_0	1	1				05/23/2018	2019.01	05/23/2018 10:31:43 AM Central Daylight Time					06/02/2018 12:38:39 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	805	0	2019	Select counties in Washington		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	806	0	1	01	01	H3805_806_0	1	1				05/23/2018	2019.01	05/23/2018 10:34:45 AM Central Daylight Time					06/02/2018 12:38:39 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	806	0	2019	Select counties in Washington		1	3480	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	807	0	1	01	01	H3805_807_0	1	1				05/23/2018	2019.01	05/23/2018 10:36:37 AM Central Daylight Time					06/02/2018 12:38:39 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	807	0	2019	Select counties in Washington		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3809	001	0	1	20	08	H3809_001_0	1	1				05/29/2018	2019.01	05/29/2018 08:26:52 PM Pacific Daylight Time		05/23/2018 01:54:11 PM Pacific Daylight Time			05/29/2018 08:31:35 PM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (dual eligible) (PACE)	08	20		1			H3809	001	0	2019	Portland Metro area and North Coast		2		2			2						http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove	http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/										(855)415-6048		(503)215-6556		(855)415-6048		(503)215-6556										(800)848-4442		(503)215-6556		(800)848-4442		(503)215-6556																
H3809	002	0	1	20	08	H3809_002_0	1	1				05/29/2018	2019.01	05/29/2018 08:29:49 PM Pacific Daylight Time		05/23/2018 01:54:11 PM Pacific Daylight Time			05/29/2018 08:31:35 PM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (private pay) (PACE)	08	20		1			H3809	002	0	2019	Portland Metro area and North Coast		2		2			2						http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove	http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/										(855)415-6048		(503)215-6556		(855)415-6048		(503)215-6556										(800)848-4442		(503)215-6556		(800)848-4442		(503)215-6556																
H3810	001	0	1	01	01	H3810_001_0	7	1				07/23/2018	2019.01	07/23/2018 08:52:28 AM Pacific Daylight Time	07/18/2018 02:37:20 PM Pacific Daylight Time				07/23/2018 10:50:04 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Gold (HMO)	01	01		1			H3810	001	0	2019	Counties:  JO, JA, DO*		2	3882	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/Advantage/Formulary	www.AllCareHealth.com/Advantage/Providers	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2	2			
H3810	003	0	1	01	01	H3810_003_0	11	1				07/31/2018	2019.01	07/31/2018 02:18:00 PM Pacific Daylight Time	08/07/2018 11:09:27 AM Pacific Daylight Time	08/07/2018 11:09:32 AM Pacific Daylight Time			08/07/2018 11:10:24 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Gold Plus Rx (HMO)	01	01		1			H3810	003	0	2019	Counties: JO, JA, DO*		2	14825	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/Advantage/Formulary	www.AllCareHealth.com/Advantage/Providers	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3810	020	0	1	01	01	H3810_020_0	11	1				08/06/2018	2019.01	08/06/2018 09:33:52 AM Pacific Daylight Time	08/07/2018 11:09:34 AM Pacific Daylight Time	08/07/2018 11:09:35 AM Pacific Daylight Time			08/07/2018 11:10:24 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Preferred Rx (HMO)	01	01		1			H3810	020	0	2019	Josephine, Jackson, Douglas*		2	19154	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/Advantage/Formulary	www.AllCareHealth.com/Advantage/Providers	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3811	001	0	1	01	01	H3811_001_0	3	1				07/17/2018	2019.01	07/17/2018 12:57:52 PM Pacific Daylight Time	07/17/2018 12:48:08 PM Pacific Daylight Time				07/17/2018 01:09:43 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Conventional Plan (HMO)	01	01		1			H3811	001	0	2019	Benton, Lincoln and Linn counties		2		2			2						https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2	2			
H3811	002	0	1	01	01	H3811_002_0	6	1				07/11/2018	2019.01	07/11/2018 11:22:20 AM Pacific Daylight Time	08/06/2018 01:48:30 PM Pacific Daylight Time	08/06/2018 01:48:32 PM Pacific Daylight Time			08/06/2018 01:53:04 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Premier Plan (HMO)	01	01		1			H3811	002	0	2019	Benton, Lincoln and Linn counties		2		2			2						https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3811	003	0	1	01	01	H3811_003_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 01:37:41 PM Pacific Daylight Time	08/06/2018 01:48:35 PM Pacific Daylight Time	08/06/2018 01:48:37 PM Pacific Daylight Time			08/06/2018 01:51:17 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Special Needs Plan (HMO SNP)	01	01		1			H3811	003	0	2019	Benton, Linn and Lincoln counties		2		2			1	3		2		2	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3811	009	0	1	01	01	H3811_009_0	7	1				08/06/2018	2019.01	08/06/2018 01:38:57 PM Pacific Daylight Time	08/06/2018 01:48:38 PM Pacific Daylight Time	08/06/2018 01:48:27 PM Pacific Daylight Time			08/06/2018 01:49:07 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Premier Plan Plus (HMO)	01	01		1			H3811	009	0	2019	Benton, Lincoln, and Linn counties		2		2			2						https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3813	001	0	1	04	01	H3813_001_0	6	1				08/10/2018	2019.01	08/10/2018 09:26:04 AM Pacific Daylight Time	08/03/2018 02:30:11 PM Pacific Daylight Time				08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPO (PPO)	01	04		1			H3813	001	0	2019	State of Oregon		2	27252	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3813	006	0	1	04	01	H3813_006_0	10	1				08/10/2018	2019.01	08/10/2018 11:11:42 AM Pacific Daylight Time	08/06/2018 10:46:45 AM Pacific Daylight Time	08/03/2018 02:30:06 PM Pacific Daylight Time			08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX (PPO)	01	04		1			H3813	006	0	2019	State of Oregon		2	83767	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3813	007	0	1	04	01	H3813_007_0	10	1				08/10/2018	2019.01	08/10/2018 11:49:30 AM Pacific Daylight Time	08/03/2018 02:30:03 PM Pacific Daylight Time	08/03/2018 02:30:01 PM Pacific Daylight Time			08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX Enhanced (PPO)	01	04		1			H3813	007	0	2019	Jackson and Josephine counties		2	513	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3813	008	0	1	04	01	H3813_008_0	10	1				08/10/2018	2019.01	08/10/2018 12:29:06 PM Pacific Daylight Time	08/03/2018 02:29:59 PM Pacific Daylight Time	08/03/2018 02:29:57 PM Pacific Daylight Time			08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX Enhanced (PPO)	01	04		1			H3813	008	0	2019	Clatsop, Lincoln, and Tillamook counties		2	83767	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3813	009	0	1	04	01	H3813_009_0	10	1				08/10/2018	2019.01	08/10/2018 12:29:46 PM Pacific Daylight Time	08/03/2018 02:29:55 PM Pacific Daylight Time	08/03/2018 02:29:52 PM Pacific Daylight Time			08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX Enhanced (PPO)	01	04		1			H3813	009	0	2019	Greater Portland Metro		2	18000	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3813	803	0	1	04	01	H3813_803_0	2	1				07/27/2018	2019.01	07/27/2018 06:13:44 PM Pacific Daylight Time					07/27/2018 07:41:02 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	EGWP PPORX (PPO)	01	04		1			H3813	803	0	2019	State of Oregon		1	7788	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3814	007	0	1	01	01	H3814_007_0	12	1	2	1		08/02/2018	2019.01	08/02/2018 09:10:51 AM Pacific Daylight Time	08/02/2018 08:50:49 AM Pacific Daylight Time	08/01/2018 12:21:23 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Special Needs Plan (HMO SNP)	01	01		1			H3814	007	0	2019	Douglas and Klamath Counties		2	24168	2			1	3		2		2	atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2	2			
H3815	001	0	1	01	01	H3815_001_0	4	1				07/13/2018	2019.01	07/13/2018 12:49:55 PM Pacific Daylight Time	08/03/2018 01:37:10 PM Pacific Daylight Time	08/03/2018 11:42:42 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan My Choice (HMO)	01	01		1			H3815	001	0	2019	LA, Orange, San Bernardino & Riverside Counties		2	116204	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	006	0	1	01	01	H3815_006_0	4	1				07/13/2018	2019.01	07/13/2018 12:54:58 PM Pacific Daylight Time	08/03/2018 01:41:44 PM Pacific Daylight Time	08/03/2018 11:44:10 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan My Choice (HMO)	01	01		1			H3815	006	0	2019	Stanislaus, San Joaquin Counties		2	92717	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	007	0	1	01	01	H3815_007_0	4	1				07/13/2018	2019.01	07/13/2018 12:50:25 PM Pacific Daylight Time	08/03/2018 01:47:22 PM Pacific Daylight Time	08/03/2018 11:45:46 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan My Choice (HMO)	01	01		1			H3815	007	0	2019	Santa Clara County		2	80900	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	008	0	1	01	01	H3815_008_0	4	1				07/13/2018	2019.01	07/13/2018 12:54:46 PM Pacific Daylight Time	08/03/2018 01:49:34 PM Pacific Daylight Time	08/03/2018 11:47:26 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	01	01		1			H3815	008	0	2019	Los Angeles and Orange Counties		2	55271	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	009	0	1	01	01	H3815_009_0	4	1				07/13/2018	2019.01	07/13/2018 12:56:31 PM Pacific Daylight Time	08/03/2018 01:53:48 PM Pacific Daylight Time	08/03/2018 11:48:44 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan CalPlus (HMO)	01	01		1			H3815	009	0	2019	Counties: RV, SB, ST, San Joaquin, SC, LA, OC, SD		2	123130	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	010	0	1	01	01	H3815_010_0	5	1		1		07/13/2018	2019.01	07/13/2018 01:07:35 PM Pacific Daylight Time	08/03/2018 01:56:18 PM Pacific Daylight Time	08/03/2018 11:50:06 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Heart & Diabetes (HMO SNP)	01	01		1			H3815	010	0	2019	Los Angeles and Orange Counties		2	14060	2			1	4			00000000000000000010		www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	011	0	1	01	01	H3815_011_0	4	1				07/13/2018	2019.01	07/13/2018 01:07:26 PM Pacific Daylight Time	08/03/2018 01:58:36 PM Pacific Daylight Time	08/03/2018 11:51:22 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan AllCare Preferred Plan (HMO)	01	01		1			H3815	011	0	2019	Stanislaus County		2	76067	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	013	0	1	01	01	H3815_013_0	4	1				07/13/2018	2019.01	07/13/2018 12:51:43 PM Pacific Daylight Time	08/03/2018 02:01:30 PM Pacific Daylight Time	08/03/2018 11:52:54 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan smartHMO (HMO)	01	01		1			H3815	013	0	2019	Los Angeles County		2	5653	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	015	0	1	01	01	H3815_015_0	4	1				08/06/2018	2019.01	08/06/2018 10:43:23 AM Pacific Daylight Time	08/03/2018 02:04:10 PM Pacific Daylight Time	08/03/2018 11:54:32 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	01	01		1			H3815	015	0	2019	San Bernardino and Riverside Counties		2	11130	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	016	0	1	01	01	H3815_016_0	4	1				07/13/2018	2019.01	07/13/2018 01:09:13 PM Pacific Daylight Time	08/03/2018 02:06:48 PM Pacific Daylight Time	08/03/2018 11:55:44 AM Pacific Daylight Time			08/06/2018 10:54:50 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	01	01		1			H3815	016	0	2019	San Diego		2	30060	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	801	0	1	01	01	H3815_801_0	2	1				07/13/2018	2019.01	07/13/2018 12:49:30 PM Pacific Daylight Time					07/13/2018 01:15:11 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	801	0	2019	Counties: RV, SB, ST, San Joaquin, SC, LA, OC, SD		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(844)227-7616		(844)227-7616		(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3817	008	1	1	04	01	H3817_008_1	8	1				07/18/2018	2019.01	07/18/2018 04:24:14 PM Mountain Daylight Time	08/01/2018 11:15:18 PM Mountain Daylight Time	08/01/2018 11:15:58 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H3817	008	1	2019	Select Counties in Oregon/Clark Co, WA	Metro	2	148770	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	008	2	1	04	01	H3817_008_2	8	1				07/18/2018	2019.01	07/18/2018 04:36:09 PM Mountain Daylight Time	08/01/2018 11:16:49 PM Mountain Daylight Time	08/01/2018 11:17:28 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H3817	008	2	2019	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	187891	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	009	1	1	04	01	H3817_009_1	9	1				07/18/2018	2019.01	07/18/2018 07:22:01 PM Mountain Daylight Time	08/01/2018 11:18:25 PM Mountain Daylight Time	08/01/2018 11:19:06 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H3817	009	1	2019	Select Counties in Oregon/Clark Co, WA	Metro	2	54517	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	009	2	1	04	01	H3817_009_2	9	1				07/18/2018	2019.01	07/18/2018 07:22:08 PM Mountain Daylight Time	08/01/2018 11:20:09 PM Mountain Daylight Time	08/01/2018 11:20:51 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H3817	009	2	2019	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	59588	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	010	0	1	04	01	H3817_010_0	6	1				07/20/2018	2019.01	07/20/2018 02:01:25 PM Mountain Daylight Time	07/19/2018 06:58:53 PM Mountain Daylight Time				07/20/2018 03:58:30 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H3817	010	0	2019	Select Counties in Oregon/Clark Co, WA		2	49524	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3817	011	1	1	04	01	H3817_011_1	8	1				07/18/2018	2019.01	07/18/2018 05:34:47 PM Mountain Daylight Time	08/01/2018 11:22:45 PM Mountain Daylight Time	08/01/2018 11:23:24 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H3817	011	1	2019	Select Counties in Oregon/Clark Co, WA	Metro	2	6048	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	011	2	1	04	01	H3817_011_2	9	1				07/23/2018	2019.01	07/23/2018 04:50:40 PM Mountain Daylight Time	08/01/2018 11:24:17 PM Mountain Daylight Time	08/01/2018 11:24:57 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H3817	011	2	2019	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	4188	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	801	0	1	04	01	H3817_801_0	1	1				05/18/2018	2019.01	05/18/2018 11:10:14 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H3817	801	0	2019	Nationwide except territories		1	25747	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3817	802	0	1	04	01	H3817_802_0	1	1				05/18/2018	2019.01	05/18/2018 11:17:56 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H3817	802	0	2019	Nationwide except territories		1	30099	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3817	803	0	1	04	01	H3817_803_0	1	1				05/18/2018	2019.01	05/18/2018 11:29:05 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	01	04		1			H3817	803	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3817	804	0	1	04	01	H3817_804_0	1	1				05/18/2018	2019.01	05/18/2018 11:38:07 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	01	04		1			H3817	804	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3822	001	0	1	01	01	H3822_001_0	8	1				07/09/2018	2019.01	07/09/2018 09:23:47 AM Mountain Daylight Time	08/06/2018 11:48:37 AM Mountain Daylight Time	08/01/2018 10:52:02 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	001	0	2019	Cook, DuPage, Will and Kane counties		2	216401	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	002	0	1	01	01	H3822_002_0	7	1				07/09/2018	2019.01	07/09/2018 09:23:57 AM Mountain Daylight Time	08/06/2018 11:49:23 AM Mountain Daylight Time	08/01/2018 10:52:48 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	002	0	2019	Bernalillo, Sandoval, Torrence and Valencia cntys		2	95124	2			2						www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	www.getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	006	0	1	01	01	H3822_006_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 01:12:54 PM Mountain Daylight Time	08/06/2018 02:13:16 PM Mountain Daylight Time	08/01/2018 10:53:37 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getbluenm.com/dsnp	Blue Cross Medicare Advantage Dual Care (HMO SNP)	01	01		1			H3822	006	0	2019	Bernalillo, Sandoval, Torrance and Valencia		2	7696	2			1	3		2		2	www.getbluenm.com/dsnp/pharmacies	www.getbluenm.com/dsnp/druglist	www.getbluenm.com/dsnp/providers	(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	007	0	1	02	01	H3822_007_0	9	1				07/09/2018	2019.01	07/09/2018 09:24:13 AM Mountain Daylight Time	08/06/2018 11:50:54 AM Mountain Daylight Time	08/01/2018 10:54:22 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic Plus (HMO-POS)	01	02		1			H3822	007	0	2019	Cook, DuPage, Kane and Will counties		2	61438	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	008	0	1	02	01	H3822_008_0	7	1				07/09/2018	2019.01	07/09/2018 09:24:27 AM Mountain Daylight Time	08/06/2018 11:51:41 AM Mountain Daylight Time	08/01/2018 10:55:07 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3822	008	0	2019	Cook, DuPage, Kane and Will counties		2	25637	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	010	0	1	02	01	H3822_010_0	7	1				07/09/2018	2019.01	07/09/2018 09:24:44 AM Mountain Daylight Time	08/06/2018 11:52:27 AM Mountain Daylight Time	08/01/2018 10:55:51 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Elite (HMO-POS)	01	02		1			H3822	010	0	2019	Dupage and Will Counties		2	2194	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	011	0	1	01	01	H3822_011_0	8	1				07/09/2018	2019.01	07/09/2018 03:02:30 PM Mountain Daylight Time	08/06/2018 11:53:13 AM Mountain Daylight Time	08/01/2018 10:56:36 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Select (HMO)	01	01		1			H3822	011	0	2019	Chicago Metro Area		2	1508	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	801	0	1	01	01	H3822_801_0	2	1				06/18/2018	2019.01	06/18/2018 01:54:50 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	801	0	2019	State of Illinois		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	802	0	1	01	01	H3822_802_0	2	1				06/18/2018	2019.01	06/18/2018 01:55:51 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	802	0	2019	State of New Mexico		1	40400	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	805	0	1	01	01	H3822_805_0	2	1				06/18/2018	2019.01	06/18/2018 01:57:19 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	805	0	2019	State of Illinois		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	806	0	1	01	01	H3822_806_0	2	1				06/18/2018	2019.01	06/18/2018 01:57:11 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	806	0	2019	State of New Mexico		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	809	0	1	01	01	H3822_809_0	2	1				06/18/2018	2019.01	06/18/2018 01:57:05 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	809	0	2019	State of Illinois		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	810	0	1	01	01	H3822_810_0	2	1				06/18/2018	2019.01	06/18/2018 01:57:39 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	810	0	2019	State of New Mexico		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	813	0	1	01	01	H3822_813_0	4	1				06/18/2018	2019.01	06/18/2018 01:58:02 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H3822	813	0	2019	State of MT		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	814	0	1	01	01	H3822_814_0	3	1				06/18/2018	2019.01	06/18/2018 01:58:13 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H3822	814	0	2019	State of MT		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3822	815	0	1	01	01	H3822_815_0	3	1				06/18/2018	2019.01	06/18/2018 01:58:24 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.hcsc.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H3822	815	0	2019	State of MT		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3832	007	0	1	04	01	H3832_007_0	7	1				08/06/2018	2019.01	08/06/2018 02:14:34 PM Hawaiian Standard Time	08/06/2018 08:20:52 AM Hawaiian Standard Time	08/01/2018 03:58:57 AM Hawaiian Standard Time			08/06/2018 04:47:18 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Standard (PPO)	01	04		1			H3832	007	0	2019	Hawaii, Kalawao, Kauai and Maui counties		2	24810	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	008	0	1	04	01	H3832_008_0	7	1				07/26/2018	2019.01	07/26/2018 10:14:21 AM Hawaiian Standard Time	08/06/2018 08:22:04 AM Hawaiian Standard Time	08/01/2018 04:00:38 AM Hawaiian Standard Time			08/06/2018 04:50:49 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Standard Plus (PPO)	01	04		1			H3832	008	0	2019	Hawaii, Kalawao, Kauai and Maui counties		2	59494	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	009	0	1	04	01	H3832_009_0	6	1				07/26/2018	2019.01	07/26/2018 10:14:36 AM Hawaiian Standard Time	08/06/2018 08:23:40 AM Hawaiian Standard Time	08/01/2018 04:01:41 AM Hawaiian Standard Time			08/06/2018 04:54:04 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Complete (PPO)	01	04		1			H3832	009	0	2019	Honolulu County		2	35589	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	010	0	1	04	01	H3832_010_0	6	1				07/26/2018	2019.01	07/26/2018 10:14:52 AM Hawaiian Standard Time	08/06/2018 08:25:52 AM Hawaiian Standard Time	08/01/2018 04:02:29 AM Hawaiian Standard Time			08/06/2018 04:56:43 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Complete Plus (PPO)	01	04		1			H3832	010	0	2019	Honolulu County		2	156573	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	011	0	1	04	01	H3832_011_0	10	1	2	1		08/10/2018	2019.01	08/10/2018 10:13:11 AM Hawaiian Standard Time	08/06/2018 11:54:35 AM Hawaiian Standard Time	08/01/2018 04:03:16 AM Hawaiian Standard Time			08/10/2018 12:42:56 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Dual Care (PPO SNP)	01	04		1			H3832	011	0	2019	Hawaii, Kalawao, Kauai, Maui and Honolulu counties		2	3660	2			1	3		1		1	www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	801	0	1	04	01	H3832_801_0	2	1				06/01/2018	2019.01	06/01/2018 04:15:39 PM Hawaiian Standard Time					06/01/2018 04:24:56 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage EGWP with Drug CY (PPO)	01	04		1			H3832	801	0	2019	National		1	58755	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	2		1									
H3832	802	0	1	04	01	H3832_802_0	2	1				06/01/2018	2019.01	06/01/2018 04:16:46 PM Hawaiian Standard Time					06/01/2018 04:34:24 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage EGWP with Drug NCY (PPO)	01	04		1			H3832	802	0	2019	National		1	0	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	2		1									
H3832	805	0	1	04	01	H3832_805_0	2	1				06/01/2018	2019.01	06/01/2018 04:17:08 PM Hawaiian Standard Time					06/01/2018 04:38:25 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage EGWP CY (PPO)	01	04		1			H3832	805	0	2019	National		1	26308	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	2		1									
H3832	807	0	1	04	01	H3832_807_0	2	1				06/01/2018	2019.01	06/01/2018 04:17:25 PM Hawaiian Standard Time					06/01/2018 04:40:02 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Union Group Plan MAPD (PPO)	01	04		1			H3832	807	0	2019	National		1	60187	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	2		1									
H3864	002	0	1	01	01	H3864_002_0	2	1				07/13/2018	2019.01	07/13/2018 08:29:14 AM Pacific Daylight Time	06/02/2018 05:25:19 PM Pacific Daylight Time				07/13/2018 10:55:31 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 2 (HMO)	01	01		1			H3864	002	0	2019	Central, Eastern, Mid-Columbia Gorge, Lane OR		2	22002	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2	2			
H3864	006	0	1	01	01	H3864_006_0	7	1				07/13/2018	2019.01	07/13/2018 08:29:08 AM Pacific Daylight Time	08/01/2018 02:21:20 PM Pacific Daylight Time	08/01/2018 10:31:28 AM Pacific Daylight Time			08/03/2018 07:24:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 6 (HMO)	01	01		1			H3864	006	0	2019	Central, Eastern Oregon and Mid-Columbia Gorge		2	15633	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	014	0	1	02	01	H3864_014_0	4	1				07/13/2018	2019.01	07/13/2018 07:30:58 AM Pacific Daylight Time	08/01/2018 09:35:56 AM Pacific Daylight Time	08/01/2018 10:32:42 AM Pacific Daylight Time			08/03/2018 07:24:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 14 (HMO-POS)	01	02		1			H3864	014	0	2019	Central, Eastern Oregon and Mid-Columbia Gorge		2	60679	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	021	0	1	01	01	H3864_021_0	4	1				07/13/2018	2019.01	07/13/2018 08:18:23 AM Pacific Daylight Time	08/01/2018 02:11:20 PM Pacific Daylight Time	08/01/2018 10:33:44 AM Pacific Daylight Time			08/03/2018 07:24:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 21 (HMO)	01	01		1			H3864	021	0	2019	Eastern Idaho		2	20678	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	024	0	1	02	01	H3864_024_0	4	1				07/13/2018	2019.01	07/13/2018 07:30:50 AM Pacific Daylight Time	08/01/2018 09:37:34 AM Pacific Daylight Time	08/01/2018 10:34:46 AM Pacific Daylight Time			08/03/2018 07:24:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)	01	02		1			H3864	024	0	2019	Southwest and Southern Idaho		2	69585	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	026	1	1	01	01	H3864_026_1	5	1				07/13/2018	2019.01	07/13/2018 08:28:59 AM Pacific Daylight Time	08/01/2018 09:38:24 AM Pacific Daylight Time	08/01/2018 10:36:00 AM Pacific Daylight Time			08/03/2018 07:24:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 26 (HMO)	01	01		1			H3864	026	1	2019	Coos, Curry and Lane Counties	Coos and Curry Counties	2	5045	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	026	2	1	01	01	H3864_026_2	4	1				07/13/2018	2019.01	07/13/2018 08:28:51 AM Pacific Daylight Time	08/01/2018 09:39:14 AM Pacific Daylight Time	08/01/2018 10:37:10 AM Pacific Daylight Time			08/03/2018 07:24:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 26 (HMO)	01	01		1			H3864	026	2	2019	Coos, Curry and Lane Counties	Lane County	2	19683	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	027	0	1	01	01	H3864_027_0	8	1				07/13/2018	2019.01	07/13/2018 08:28:42 AM Pacific Daylight Time	08/01/2018 02:28:34 PM Pacific Daylight Time	08/01/2018 10:38:34 AM Pacific Daylight Time			08/03/2018 07:53:13 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 27 (HMO)	01	01		1			H3864	027	0	2019	Central, Eastern Oregon and Mid-Columbia Gorge		2	23407	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	029	0	1	01	01	H3864_029_0	5	1				07/13/2018	2019.01	07/13/2018 08:21:00 AM Pacific Daylight Time	08/01/2018 02:33:00 PM Pacific Daylight Time	08/01/2018 10:39:58 AM Pacific Daylight Time			08/03/2018 07:53:13 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 29 (HMO)	01	01		1			H3864	029	0	2019	Yellowstone County		2	3564	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	030	0	1	01	01	H3864_030_0	2	1				07/13/2018	2019.01	07/13/2018 08:21:46 AM Pacific Daylight Time	07/13/2018 10:00:10 AM Pacific Daylight Time				07/13/2018 10:10:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare 30 (HMO)	01	01		1			H3864	030	0	2019	Yellowstone County		2	912	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2	2			
H3864	032	0	1	01	01	H3864_032_0	5	1				07/13/2018	2019.01	07/13/2018 08:28:32 AM Pacific Daylight Time	08/01/2018 09:42:32 AM Pacific Daylight Time	08/01/2018 10:41:04 AM Pacific Daylight Time			08/03/2018 07:53:13 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 32 (HMO)	01	01		1			H3864	032	0	2019	Southwest Idaho		2	38562	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	033	0	1	01	01	H3864_033_0	4	1				07/13/2018	2019.01	07/13/2018 08:28:26 AM Pacific Daylight Time	08/01/2018 02:40:08 PM Pacific Daylight Time	08/01/2018 10:42:08 AM Pacific Daylight Time			08/03/2018 07:53:13 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 33 (HMO)	01	01		1			H3864	033	0	2019	Spokane County		2	100	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	034	0	1	01	01	H3864_034_0	4	1				07/13/2018	2019.01	07/13/2018 08:28:19 AM Pacific Daylight Time	08/01/2018 02:43:38 PM Pacific Daylight Time	08/01/2018 10:43:06 AM Pacific Daylight Time			08/03/2018 08:01:39 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 34 (HMO)	01	01		1			H3864	034	0	2019	Pierce County		2	100	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	035	0	1	01	01	H3864_035_0	2	1				07/13/2018	2019.01	07/13/2018 08:28:12 AM Pacific Daylight Time	07/13/2018 10:00:12 AM Pacific Daylight Time				07/13/2018 10:10:15 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare 35 (HMO)	01	01		1			H3864	035	0	2019	Spokane and Pierce Counties		2	100	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2	2			
H3864	036	0	1	01	01	H3864_036_0	4	1				07/13/2018	2019.01	07/13/2018 08:28:04 AM Pacific Daylight Time	08/01/2018 09:45:46 AM Pacific Daylight Time	08/01/2018 10:44:06 AM Pacific Daylight Time			08/03/2018 08:01:39 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 36 (HMO)	01	01		1			H3864	036	0	2019	Lane County		2	100	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	037	0	1	01	01	H3864_037_0	6	1				07/13/2018	2019.01	07/13/2018 08:27:56 AM Pacific Daylight Time	08/01/2018 09:46:32 AM Pacific Daylight Time	08/01/2018 10:45:06 AM Pacific Daylight Time			08/03/2018 08:01:39 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 37 (HMO)	01	01		1			H3864	037	0	2019	Clark County		2	12348	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	038	0	1	01	01	H3864_038_0	4	1				07/13/2018	2019.01	07/13/2018 08:27:48 AM Pacific Daylight Time	08/01/2018 02:57:50 PM Pacific Daylight Time	08/01/2018 10:46:12 AM Pacific Daylight Time			08/03/2018 08:01:39 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 38 (HMO)	01	01		1			H3864	038	0	2019	Clark County		2	12348	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	039	0	1	01	01	H3864_039_0	4	1				07/13/2018	2019.01	07/13/2018 08:27:39 AM Pacific Daylight Time	08/01/2018 09:48:06 AM Pacific Daylight Time	08/01/2018 10:47:12 AM Pacific Daylight Time			08/03/2018 08:19:46 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 39 (HMO)	01	01		1			H3864	039	0	2019	Portland Metro Area		2	2988	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	040	0	1	01	01	H3864_040_0	6	1				07/13/2018	2019.01	07/13/2018 08:27:32 AM Pacific Daylight Time	08/01/2018 09:48:52 AM Pacific Daylight Time	08/01/2018 10:48:12 AM Pacific Daylight Time			08/03/2018 08:19:46 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 40 (HMO)	01	01		1			H3864	040	0	2019	Portland Metro Area		2	2988	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	801	0	1	01	01	H3864_801_0	1	1				06/02/2018	2019.01	06/02/2018 12:51:20 PM Pacific Daylight Time					06/03/2018 11:40:59 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 801 (HMO)	01	01		1			H3864	801	0	2019	Statewide - Oregon, Idaho, Montana and Washington		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3864	803	0	1	01	01	H3864_803_0	1	1				06/02/2018	2019.01	06/02/2018 12:51:28 PM Pacific Daylight Time					06/03/2018 11:40:59 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 803 (HMO)	01	01		1			H3864	803	0	2019	Statewide - Oregon, Idaho, Montana and Washington		1	11808	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3864	805	0	1	02	01	H3864_805_0	1	1				06/02/2018	2019.01	06/02/2018 12:51:41 PM Pacific Daylight Time					06/03/2018 11:40:59 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 805 (HMO-POS)	01	02		1			H3864	805	0	2019	Statewide - Oregon, Idaho, Montana and Washington		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1				
H3864	806	0	1	02	01	H3864_806_0	1	1				06/02/2018	2019.01	06/02/2018 12:51:48 PM Pacific Daylight Time					06/03/2018 11:40:59 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 806 (HMO-POS)	01	02		1			H3864	806	0	2019	Statewide - Oregon, Idaho, Montana and Washington		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1				
H3890	001	0	1	04	01	H3890_001_0	10	1				08/01/2018	2019.01	08/01/2018 11:23:46 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time			08/06/2018 10:06:35 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	http://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (PPO)	01	04		1			H3890	001	0	2019	Counties: AA BL BC CV CR FR HW MG SS WH WC WR		2	38810	2			2						http://www.hopkinsmedicare.com/	http://www.hopkinsmedicare.com/	http://www.hopkinsmedicare.com/	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3890	002	0	1	04	01	H3890_002_0	9	1				07/09/2018	2019.01	07/09/2018 11:30:26 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time	08/06/2018 10:03:23 AM Eastern Daylight Time			08/06/2018 10:06:35 AM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	http://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Plus (PPO)	01	04		1			H3890	002	0	2019	Counties: AA BL BC CV CR FR HW MG SS WH WC WR		2	58136	2			2						http://www.hopkinsmedicare.com/	http://www.hopkinsmedicare.com/	http://www.hopkinsmedicare.com/	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3890	801	0	1	04	01	H3890_801_0	6	1				05/29/2018	2019.01	05/29/2018 10:54:48 AM Eastern Daylight Time					06/03/2018 01:29:33 PM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan CY (PPO)	01	04		1			H3890	801	0	2019	All Counties in Maryland		1	1200	2			2						www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;	2		1									
H3890	802	0	1	04	01	H3890_802_0	6	1				04/13/2018	2019.01	04/13/2018 10:55:19 AM Eastern Daylight Time					06/03/2018 01:29:33 PM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan Non-CY (PPO)	01	04		1			H3890	802	0	2019	All Counties in Maryland		1	0	2			2						www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;	2		1									
H3890	803	0	1	04	01	H3890_803_0	6	1				04/13/2018	2019.01	04/13/2018 10:55:33 AM Eastern Daylight Time					06/03/2018 01:29:33 PM Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan MA Only (PPO)	01	04		1			H3890	803	0	2019	All Counties in Maryland		1	0	2			2						www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;	2		1									
H3907	002	0	1	01	01	H3907_002_0	6	1			1	07/13/2018	2019.01	07/13/2018 08:22:36 AM Eastern Daylight Time	06/01/2018 06:47:40 PM Eastern Daylight Time				07/13/2018 04:01:03 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life (HMO)	01	01		1			H3907	002	0	2019	Western and North Eastern PA		2	226745	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										2					2					2	2			
H3907	006	0	1	01	01	H3907_006_0	7	1			1	07/13/2018	2019.01	07/13/2018 08:36:27 AM Eastern Daylight Time	08/02/2018 12:38:43 PM Eastern Daylight Time	08/01/2018 10:29:15 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx Enhanced (HMO)	01	01		1			H3907	006	0	2019	Western and North Eastern PA		2	40523	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	029	0	1	01	01	H3907_029_0	7	1			1	07/13/2018	2019.01	07/13/2018 08:31:43 AM Eastern Daylight Time	08/02/2018 02:18:44 PM Eastern Daylight Time	08/01/2018 10:35:23 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	01	01		1			H3907	029	0	2019	Western, Central, and North Eastern PA		2	826447	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	037	0	1	01	01	H3907_037_0	7	1			1	07/13/2018	2019.01	07/13/2018 08:40:53 AM Eastern Daylight Time	08/02/2018 12:40:27 PM Eastern Daylight Time	08/01/2018 11:04:55 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Deductible with Rx (HMO)	01	01		1			H3907	037	0	2019	Western, Central, and North Eastern PA		2	549931	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	042	0	1	01	01	H3907_042_0	5	1			2	07/13/2018	2019.01	07/13/2018 09:07:00 AM Eastern Daylight Time	08/01/2018 01:01:40 PM Eastern Daylight Time	08/01/2018 11:07:38 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	01	01		1			H3907	042	0	2019	Bucks, Chester, Montgomery, Philadelphia Counties		2	1000	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	043	0	1	01	01	H3907_043_0	5	1			2	07/13/2018	2019.01	07/13/2018 09:10:39 AM Eastern Daylight Time	08/01/2018 01:46:08 PM Eastern Daylight Time	08/01/2018 11:10:15 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Deductible with Rx (HMO)	01	01		1			H3907	043	0	2019	Bucks, Chester, Montgomery, Philadelphia Counties		2	1780	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	044	0	1	01	01	H3907_044_0	5	1			2	07/13/2018	2019.01	07/13/2018 08:59:07 AM Eastern Daylight Time	08/01/2018 01:47:54 PM Eastern Daylight Time	08/01/2018 11:14:01 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Deductible with Rx (HMO)	01	01		1			H3907	044	0	2019	Delaware County		2	1756	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	045	0	1	01	01	H3907_045_0	5	1			2	07/13/2018	2019.01	07/13/2018 08:22:46 AM Eastern Daylight Time	08/01/2018 01:49:38 PM Eastern Daylight Time	07/31/2018 05:58:19 PM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	045	0	2019	Berks County		2	6040	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	046	0	1	01	01	H3907_046_0	5	1			2	07/12/2018	2019.01	07/12/2018 05:27:18 PM Eastern Daylight Time	08/01/2018 01:51:46 PM Eastern Daylight Time	07/31/2018 05:59:53 PM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	046	0	2019	Allghny Beaver Bedford Blair Butler Lycoming Tioga		2	24127	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	047	0	1	01	01	H3907_047_0	5	1			2	07/13/2018	2019.01	07/13/2018 08:48:56 AM Eastern Daylight Time	08/01/2018 01:53:00 PM Eastern Daylight Time	08/01/2018 11:16:24 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	01	01		1			H3907	047	0	2019	Berks County		2	2365	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	048	0	1	01	01	H3907_048_0	5	1			2	07/13/2018	2019.01	07/13/2018 09:03:58 AM Eastern Daylight Time	08/01/2018 01:56:48 PM Eastern Daylight Time	08/01/2018 11:18:15 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	01	01		1			H3907	048	0	2019	Delaware County		2	822	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	049	0	1	01	01	H3907_049_0	6	1			2	07/12/2018	2019.01	07/12/2018 06:00:18 PM Eastern Daylight Time	08/01/2018 02:00:36 PM Eastern Daylight Time	08/01/2018 11:23:05 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx Choice (HMO)	01	01		1			H3907	049	0	2019	Erie, Lawrence, Mercer, Venango Counties		2	2466	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	050	0	1	01	01	H3907_050_0	5	1			2	07/12/2018	2019.01	07/12/2018 06:02:01 PM Eastern Daylight Time	08/01/2018 02:06:32 PM Eastern Daylight Time	07/31/2018 06:01:24 PM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	050	0	2019	Erie, Lawrence, Mercer, Venango Counties		2	5422	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	051	0	1	01	01	H3907_051_0	5	1			2	07/13/2018	2019.01	07/13/2018 08:44:46 AM Eastern Daylight Time	08/01/2018 02:08:30 PM Eastern Daylight Time	07/31/2018 06:02:56 PM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	051	0	2019	Westmoreland County		2	736	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	052	0	1	01	01	H3907_052_0	5	1			2	07/13/2018	2019.01	07/13/2018 08:54:13 AM Eastern Daylight Time	08/01/2018 02:13:20 PM Eastern Daylight Time	07/31/2018 06:04:25 PM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	052	0	2019	Cumberland and Dauphin Counties		2	740	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	801	0	1	01	01	H3907_801_0	2	1				06/01/2018	2019.01	06/01/2018 10:38:38 AM Eastern Daylight Time					06/01/2018 08:32:29 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC Employer Group (HMO)	01	01		1			H3907	801	0	2019	Western Pennsylvania		1	111014	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										1	1	1a;1b;2;6;7b;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					1				
H3907	802	0	1	01	01	H3907_802_0	2	1				06/01/2018	2019.01	06/01/2018 10:08:43 AM Eastern Daylight Time					06/01/2018 08:32:29 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	01	01		1			H3907	802	0	2019	Western Pennsylvania		1	49122	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;6;7b;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					1				
H3907	803	0	1	01	01	H3907_803_0	2	1				06/01/2018	2019.01	06/01/2018 10:14:40 AM Eastern Daylight Time					06/01/2018 08:32:29 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	01	01		1			H3907	803	0	2019	Western Pennsylvania		1	12	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;6;7b;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					1				
H3908	001	0	1	20	08	H3908_001_0	1	1				05/23/2018	2019.01	05/23/2018 02:54:25 PM Eastern Daylight Time		05/21/2018 09:17:58 AM Eastern Daylight Time			05/23/2018 02:57:44 PM Eastern Daylight Time	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	Mercy LIFE - West Philadelphia	http://www.mercylife-westphila.org	Trinity Health LIFE Pennsylvania (PACE)	08	20		1			H3908	001	0	2019	Philadelphia and Delaware County, PA		2		2			2						www.CareKinesis.com	http://www.mercyhealth.org/services/mercy-life/west-phila/										(267)787-8300		(267)787-8300		(267)787-8300		(267)787-8300										(800)654-5984		(800)654-5984		(800)654-5984		(800)654-5984																
H3908	002	0	1	20	08	H3908_002_0	1	1				05/23/2018	2019.01	05/23/2018 02:55:19 PM Eastern Daylight Time		05/21/2018 09:17:42 AM Eastern Daylight Time			05/23/2018 02:57:44 PM Eastern Daylight Time	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	Mercy LIFE - West Philadelphia	http://www.mercylife-westphila.org	Trinity Health LIFE Pennsylvania (PACE)	08	20		1			H3908	002	0	2019	Philadelphia and Delaware County, PA		2		2			2						www.CareKinesis.com	http://www.mercyhealth.org/services/mercy-life/west-phila/										(267)787-8300		(267)787-8300		(267)787-8300		(267)787-8300										(800)654-5984		(800)654-5984		(800)654-5984		(800)654-5984																
H3909	001	0	1	04	01	H3909_001_0	17	1				07/27/2018	2019.01	07/27/2018 11:38:07 AM Eastern Daylight Time	08/06/2018 01:54:08 PM Eastern Daylight Time	08/02/2018 09:47:30 AM Eastern Daylight Time			08/06/2018 03:31:42 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	001	0	2019	Bucks, Philadelphia Counties		2	9999	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3909	007	0	1	04	01	H3909_007_0	4	1				07/27/2018	2019.01	07/27/2018 11:38:55 AM Eastern Daylight Time	07/27/2018 03:43:39 PM Eastern Daylight Time				07/27/2018 03:50:38 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Medical Only (PPO)	01	04		1			H3909	007	0	2019	Bucks, Philadelphia Counties		2	9999	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3909	009	0	1	04	01	H3909_009_0	8	1				07/27/2018	2019.01	07/27/2018 11:39:08 AM Eastern Daylight Time	08/03/2018 10:02:58 AM Eastern Daylight Time	08/02/2018 09:47:36 AM Eastern Daylight Time			08/03/2018 03:41:35 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	009	0	2019	Chester, Delaware, Montgomery Counties		2	9999	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3909	801	0	1	04	01	H3909_801_0	1	1				05/31/2018	2019.01	05/31/2018 04:02:32 PM Eastern Daylight Time					06/02/2018 08:34:10 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Medical Only (PPO)	01	04		1			H3909	801	0	2019	National		1	6659	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1									
H3909	802	0	1	04	01	H3909_802_0	1	1				05/31/2018	2019.01	05/31/2018 04:03:53 PM Eastern Daylight Time					06/02/2018 08:36:13 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Rx (PPO)	01	04		1			H3909	802	0	2019	National		1	16219	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1									
H3916	001	0	1	04	01	H3916_001_0	8	1				05/21/2018	2019.01	05/21/2018 02:35:38 PM Eastern Daylight Time	08/01/2018 08:39:48 PM Eastern Daylight Time	08/01/2018 10:56:27 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	001	0	2019	Southwestern PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	002	0	1	04	01	H3916_002_0	8	1				05/21/2018	2019.01	05/21/2018 02:36:48 PM Eastern Daylight Time	08/01/2018 08:40:24 PM Eastern Daylight Time	08/01/2018 11:29:33 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	002	0	2019	West Central PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	005	0	1	04	01	H3916_005_0	8	1				05/18/2018	2019.01	05/18/2018 01:51:32 PM Eastern Daylight Time	08/01/2018 08:41:02 PM Eastern Daylight Time	08/01/2018 11:31:37 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Deluxe (PPO)	01	04		1			H3916	005	0	2019	Central and Northeastern PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	012	0	1	04	01	H3916_012_0	7	1				05/14/2018	2019.01	05/14/2018 01:49:36 PM Eastern Daylight Time	06/03/2018 02:27:04 PM Eastern Daylight Time				06/04/2018 08:54:15 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Basic (PPO)	01	04		1			H3916	012	0	2019	Central and Northeastern PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3916	015	0	1	04	01	H3916_015_0	8	1				05/18/2018	2019.01	05/18/2018 01:52:05 PM Eastern Daylight Time	08/01/2018 08:42:14 PM Eastern Daylight Time	08/01/2018 11:33:12 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Standard (PPO)	01	04		1			H3916	015	0	2019	Central and Northeastern PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	018	0	1	04	01	H3916_018_0	8	1				05/18/2018	2019.01	05/18/2018 01:52:32 PM Eastern Daylight Time	08/02/2018 03:53:25 PM Eastern Daylight Time	08/01/2018 11:34:33 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	018	0	2019	Central and Northeastern PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	022	0	1	04	01	H3916_022_0	8	1				05/21/2018	2019.01	05/21/2018 02:32:33 PM Eastern Daylight Time	08/01/2018 08:46:41 PM Eastern Daylight Time	08/01/2018 11:36:03 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Select (PPO)	01	04		1			H3916	022	0	2019	Southwestern PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	024	0	1	04	01	H3916_024_0	8	1				05/21/2018	2019.01	05/21/2018 02:34:04 PM Eastern Daylight Time	08/01/2018 08:47:11 PM Eastern Daylight Time	08/01/2018 11:37:28 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Select (PPO)	01	04		1			H3916	024	0	2019	West Central PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	032	0	1	04	01	H3916_032_0	8	1				05/21/2018	2019.01	05/21/2018 02:28:56 PM Eastern Daylight Time	08/03/2018 08:14:19 AM Eastern Daylight Time	08/01/2018 11:38:46 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	032	0	2019	Southwestern PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	033	0	1	04	01	H3916_033_0	8	1				05/21/2018	2019.01	05/21/2018 02:27:13 PM Eastern Daylight Time	08/01/2018 08:48:11 PM Eastern Daylight Time	08/01/2018 11:40:01 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	033	0	2019	West Central PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	034	1	1	04	01	H3916_034_1	8	1				05/18/2018	2019.01	05/18/2018 01:55:30 PM Eastern Daylight Time	08/01/2018 08:48:40 PM Eastern Daylight Time	08/01/2018 11:39:28 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	034	1	2019	North Central	Lehigh Valley	2	1	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	034	3	1	04	01	H3916_034_3	8	1				05/18/2018	2019.01	05/18/2018 01:55:49 PM Eastern Daylight Time	08/01/2018 08:49:10 PM Eastern Daylight Time	08/01/2018 11:43:26 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	034	3	2019	North Central	Harrisburg	2	1	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	034	4	1	04	01	H3916_034_4	8	1				05/18/2018	2019.01	05/18/2018 01:56:05 PM Eastern Daylight Time	08/01/2018 08:49:40 PM Eastern Daylight Time	08/01/2018 11:41:22 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	034	4	2019	North Central	North Central	2	1	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	034	5	1	04	01	H3916_034_5	8	1				05/18/2018	2019.01	05/18/2018 01:56:25 PM Eastern Daylight Time	08/01/2018 08:50:19 PM Eastern Daylight Time	08/01/2018 11:42:38 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	034	5	2019	North Central	Lancaster	2	1	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	035	1	1	04	01	H3916_035_1	8	1				05/18/2018	2019.01	05/18/2018 01:56:58 PM Eastern Daylight Time	08/01/2018 08:50:48 PM Eastern Daylight Time	08/01/2018 11:36:42 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	035	1	2019	Western PA	Southwest	2	1	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	035	2	1	04	01	H3916_035_2	8	1				05/18/2018	2019.01	05/18/2018 01:57:21 PM Eastern Daylight Time	08/01/2018 08:51:16 PM Eastern Daylight Time	08/01/2018 11:38:08 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	035	2	2019	Western PA	West Central	2	1	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	036	0	1	04	01	H3916_036_0	8	1				05/18/2018	2019.01	05/18/2018 01:57:44 PM Eastern Daylight Time	08/01/2018 08:51:44 PM Eastern Daylight Time	08/01/2018 11:35:20 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare Plus PPO Distinct (PPO)	01	04		1			H3916	036	0	2019	Counties: TA, LG, SN, CN		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	801	0	1	04	01	H3916_801_0	6	1				05/02/2018	2019.01	05/02/2018 03:50:29 PM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO MA PA CALENDAR (PPO)	01	04		1			H3916	801	0	2019	Pennsylvania		1	303096	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3916	802	0	1	04	01	H3916_802_0	6	1				05/02/2018	2019.01	05/02/2018 03:50:56 PM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO MAPD PA CALENDAR (PPO)	01	04		1			H3916	802	0	2019	Pennsylvania		1	524928	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3916	804	0	1	04	01	H3916_804_0	7	1				06/19/2018	2019.01	06/19/2018 11:57:06 AM Eastern Daylight Time					06/19/2018 11:57:20 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO MAPD PA Non-Calendar (PPO)	01	04		1			H3916	804	0	2019	Pennsylvania		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3916	805	0	1	04	01	H3916_805_0	6	1				05/02/2018	2019.01	05/02/2018 03:51:25 PM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO MA PA Calendar (PPO)	01	04		1			H3916	805	0	2019	Pennsylvania		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3916	806	0	1	04	01	H3916_806_0	6	1				05/02/2018	2019.01	05/02/2018 03:51:45 PM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare PPO PA MAPD Calendar (PPO)	01	04		1			H3916	806	0	2019	Pennsylvania		1	6192	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3916	807	0	1	04	01	H3916_807_0	6	1				05/22/2018	2019.01	05/22/2018 09:08:07 AM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Community Blue Medicare Plus PPO Distinct MAPD Cal (PPO)	01	04		1			H3916	807	0	2019	Pennsylvania		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3917	001	0	1	20	08	H3917_001_0	1	1				05/22/2018	2019.01	05/22/2018 05:53:55 PM Eastern Daylight Time		05/22/2018 10:27:26 AM Eastern Daylight Time			05/22/2018 05:59:34 PM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Pittsburgh Care Partnership, Inc. (PACE)	08	20		1			H3917	001	0	2019	Allegheny Westmoreland Washington Co. Partial Area		2		2			2						www.commlife.org	www.commlife.org										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(711)-		(711)-		(711)-		(711)-																
H3917	002	0	1	20	08	H3917_002_0	1	1				05/22/2018	2019.01	05/22/2018 05:55:19 PM Eastern Daylight Time		05/22/2018 10:28:56 AM Eastern Daylight Time			05/22/2018 05:59:34 PM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Pittsburgh Care Partnership, Inc. (PACE)	08	20		1			H3917	002	0	2019	Allegheny Westmoreland Washington Co. Partial Area		2		2			2						www.commlife.org	www.commlife.org										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(711)-		(711)-		(711)-		(711)-																
H3918	001	0	1	20	08	H3918_001_0	1	1				05/22/2018	2019.01	05/22/2018 02:40:52 PM Eastern Daylight Time		05/22/2018 02:27:55 PM Eastern Daylight Time			05/22/2018 02:52:18 PM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Dual Eligibles Pharmacy (PACE)	08	20		1			H3918	001	0	2019	Partial Allegheny*		2		2			2						none	not applicable -- no formulary										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042																
H3918	002	0	1	20	08	H3918_002_0	1	1				05/22/2018	2019.01	05/22/2018 02:41:25 PM Eastern Daylight Time		05/22/2018 02:27:38 PM Eastern Daylight Time			05/22/2018 02:52:18 PM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Medicare Only Pharmacy (PACE)	08	20		1			H3918	002	0	2019	Partial Allegheny *		2		2			2						none	not applicable -- no formulary										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042																
H3919	001	0	1	20	08	H3919_001_0	1	1				05/23/2018	2019.01	05/23/2018 12:17:57 PM Eastern Daylight Time		05/23/2018 11:56:50 AM Eastern Daylight Time			05/23/2018 12:24:30 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	08	20		1			H3919	001	0	2019	Philadelphia (partial) & Delaware Counties		2		2			2						www.mercylife.org	www.mercylife.org										(215)339-4747		(215)339-4747		(215)339-4747		(215)339-4747										(215)339-4747		(215)339-4747		(215)339-4747		(215)339-4747																
H3919	002	0	1	20	08	H3919_002_0	1	1				05/23/2018	2019.01	05/23/2018 12:19:14 PM Eastern Daylight Time		05/23/2018 11:56:34 AM Eastern Daylight Time			05/23/2018 12:24:30 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	08	20		1			H3919	002	0	2019	Philadelphia (partial) & Delaware Counties		2		2			2						www.mercylife.org	www.mercylife.org										(215)339-4747		(215)339-4747		(215)339-4747		(215)339-4747										(215)339-4747		(215)339-4747		(215)339-4747		(215)339-4747																
H3923	013	0	1	04	01	H3923_013_0	3	1				07/09/2018	2019.01	07/09/2018 02:08:17 PM Eastern Daylight Time	08/02/2018 01:51:06 PM Eastern Daylight Time	08/02/2018 01:52:14 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Classic (PPO)	01	04		1			H3923	013	0	2019	21 Counties in Central PA		2	100836	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3923	017	0	1	04	01	H3923_017_0	3	1				07/09/2018	2019.01	07/09/2018 02:19:21 PM Eastern Daylight Time	08/02/2018 01:54:00 PM Eastern Daylight Time	08/02/2018 01:55:28 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Prime (PPO)	01	04		1			H3923	017	0	2019	21 Counties in Central PA		2	47580	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3923	801	0	1	04	01	H3923_801_0	1	1				06/02/2018	2019.01	06/02/2018 02:39:02 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney ERP with Rx (PPO)	01	04		1			H3923	801	0	2019	National		1	5912	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3923	802	0	1	04	01	H3923_802_0	1	1				06/02/2018	2019.01	06/02/2018 02:39:09 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney ERP without Rx (PPO)	01	04		1			H3923	802	0	2019	National		1	592	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3923	803	0	1	04	01	H3923_803_0	1	1				06/02/2018	2019.01	06/02/2018 02:39:15 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney ERP Non-Calendar with Rx (PPO)	01	04		1			H3923	803	0	2019	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H3924	059	10	1	04	01	H3924_059_10	4	1				08/06/2018	2019.01	08/06/2018 11:35:44 AM Eastern Daylight Time	08/06/2018 12:05:54 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	10	2019	Pennsylvania	Midwest	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	11	1	04	01	H3924_059_11	4	1				08/06/2018	2019.01	08/06/2018 11:36:26 AM Eastern Daylight Time	08/06/2018 12:05:54 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	11	2019	Pennsylvania	Bradford, Tioga	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	12	1	04	01	H3924_059_12	4	1				08/06/2018	2019.01	08/06/2018 11:36:46 AM Eastern Daylight Time	08/06/2018 12:05:55 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	12	2019	Pennsylvania	Lackawanna, Pike, Susquehanna, Wayne, Wyoming	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	13	1	04	01	H3924_059_13	4	1				08/06/2018	2019.01	08/06/2018 11:37:18 AM Eastern Daylight Time	08/06/2018 12:05:55 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	13	2019	Pennsylvania	Midstate	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	14	1	04	01	H3924_059_14	4	1				08/06/2018	2019.01	08/06/2018 11:37:45 AM Eastern Daylight Time	08/06/2018 12:05:55 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	14	2019	Pennsylvania	Central	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	15	1	04	01	H3924_059_15	4	1				08/06/2018	2019.01	08/06/2018 11:38:27 AM Eastern Daylight Time	08/06/2018 12:05:55 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	15	2019	Pennsylvania	Bucks, Carbon, Lehigh, Monroe, Northampton	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	16	1	04	01	H3924_059_16	4	1				08/06/2018	2019.01	08/06/2018 11:38:44 AM Eastern Daylight Time	08/06/2018 12:05:56 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	16	2019	Pennsylvania	Franklin	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	17	1	04	01	H3924_059_17	4	1				08/06/2018	2019.01	08/06/2018 11:39:17 AM Eastern Daylight Time	08/06/2018 12:05:56 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	17	2019	Pennsylvania	Berks, Cumberland, Dauphin, Lancaster, Perry	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	059	18	1	04	01	H3924_059_18	4	1				08/06/2018	2019.01	08/06/2018 11:40:00 AM Eastern Daylight Time	08/06/2018 12:05:56 PM Eastern Daylight Time	08/06/2018 12:06:19 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	18	2019	Pennsylvania	Adams, Lebanon, York	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	10	1	04	01	H3924_060_10	4	1				08/06/2018	2019.01	08/06/2018 11:44:19 AM Eastern Daylight Time	08/06/2018 12:05:56 PM Eastern Daylight Time	08/06/2018 12:06:20 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	10	2019	Pennsylvania	Midwest	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	11	1	04	01	H3924_060_11	4	1				08/06/2018	2019.01	08/06/2018 11:45:45 AM Eastern Daylight Time	08/06/2018 12:05:57 PM Eastern Daylight Time	08/06/2018 12:06:20 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	11	2019	Pennsylvania	Bradford, Tioga	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	12	1	04	01	H3924_060_12	4	1				08/06/2018	2019.01	08/06/2018 11:45:53 AM Eastern Daylight Time	08/06/2018 12:05:57 PM Eastern Daylight Time	08/06/2018 12:06:20 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	12	2019	Pennsylvania	Lackawanna, Pike, Susquehanna, Wayne, Wyoming	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	13	1	04	01	H3924_060_13	4	1				08/06/2018	2019.01	08/06/2018 11:46:06 AM Eastern Daylight Time	08/06/2018 12:05:57 PM Eastern Daylight Time	08/06/2018 12:06:20 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	13	2019	Pennsylvania	Midstate	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	14	1	04	01	H3924_060_14	4	1				08/06/2018	2019.01	08/06/2018 11:46:55 AM Eastern Daylight Time	08/06/2018 12:05:57 PM Eastern Daylight Time	08/06/2018 12:06:13 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	14	2019	Pennsylvania	Central	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	15	1	04	01	H3924_060_15	4	1				08/06/2018	2019.01	08/06/2018 11:47:09 AM Eastern Daylight Time	08/06/2018 12:05:59 PM Eastern Daylight Time	08/06/2018 12:06:13 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	15	2019	Pennsylvania	Bucks, Carbon, Lehigh, Monroe, Northampton	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	16	1	04	01	H3924_060_16	4	1				08/06/2018	2019.01	08/06/2018 11:47:16 AM Eastern Daylight Time	08/06/2018 12:05:59 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	16	2019	Pennsylvania	Franklin	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	17	1	04	01	H3924_060_17	4	1				08/06/2018	2019.01	08/06/2018 11:47:24 AM Eastern Daylight Time	08/06/2018 12:05:59 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	17	2019	Pennsylvania	Berks, Cumberland, Dauphin, Lancaster, Perry	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	060	18	1	04	01	H3924_060_18	4	1				08/06/2018	2019.01	08/06/2018 11:47:32 AM Eastern Daylight Time	08/06/2018 12:05:59 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	18	2019	Pennsylvania	Adams, Lebanon, York	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	10	1	04	01	H3924_062_10	3	1				08/06/2018	2019.01	08/06/2018 11:48:53 AM Eastern Daylight Time	08/06/2018 12:06:00 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	10	2019	Pennsylvania	Midwest	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	11	1	04	01	H3924_062_11	3	1				08/06/2018	2019.01	08/06/2018 11:50:10 AM Eastern Daylight Time	08/06/2018 12:06:00 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	11	2019	Pennsylvania	Bradford, Tioga	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	12	1	04	01	H3924_062_12	3	1				08/06/2018	2019.01	08/06/2018 11:50:17 AM Eastern Daylight Time	08/06/2018 12:06:00 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	12	2019	Pennsylvania	Lackawanna, Pike, Susquehanna, Wayne, Wyoming	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	13	1	04	01	H3924_062_13	3	1				08/06/2018	2019.01	08/06/2018 11:50:27 AM Eastern Daylight Time	08/06/2018 12:06:00 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	13	2019	Pennsylvania	Midstate	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	14	1	04	01	H3924_062_14	3	1				08/06/2018	2019.01	08/06/2018 11:50:51 AM Eastern Daylight Time	08/06/2018 12:06:01 PM Eastern Daylight Time	08/06/2018 12:06:14 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	14	2019	Pennsylvania	Central	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	15	1	04	01	H3924_062_15	3	1				08/06/2018	2019.01	08/06/2018 11:50:59 AM Eastern Daylight Time	08/06/2018 12:06:01 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	15	2019	Pennsylvania	Bucks, Carbon, Lehigh, Monroe, Northampton	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	16	1	04	01	H3924_062_16	3	1				08/06/2018	2019.01	08/06/2018 11:51:07 AM Eastern Daylight Time	08/06/2018 12:06:01 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	16	2019	Pennsylvania	Franklin	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	17	1	04	01	H3924_062_17	3	1				08/06/2018	2019.01	08/06/2018 11:51:15 AM Eastern Daylight Time	08/06/2018 12:06:01 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	17	2019	Pennsylvania	Berks, Cumberland, Dauphin, Lancaster, Perry	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	062	18	1	04	01	H3924_062_18	3	1				08/06/2018	2019.01	08/06/2018 11:51:23 AM Eastern Daylight Time	08/06/2018 12:06:01 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	18	2019	Pennsylvania	Adams, Lebanon, York	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	803	0	1	04	01	H3924_803_0	2	1				04/24/2018	2019.01	04/24/2018 08:57:45 PM Eastern Daylight Time					06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Rx EGWP PA (PPO)	01	04		1			H3924	803	0	2019	Pike County Pennsylvania		1	600	2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3925	001	0	1	20	08	H3925_001_0	1	1				05/25/2018	2019.01	05/25/2018 10:04:08 AM Eastern Daylight Time		05/25/2018 09:43:55 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifepa.com	Senior LIFE Johnstown Dual Eligible (PACE)	08	20		1			H3925	001	0	2019	Senior LIFE Cambria Somerset County Dual		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3925	002	0	1	20	08	H3925_002_0	1	1				05/25/2018	2019.01	05/25/2018 10:04:20 AM Eastern Daylight Time		05/25/2018 09:43:54 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifejohnstown.com	Senior LIFE Johnstown MC Only (PACE)	08	20		1			H3925	002	0	2019	Senior LIFE Cambria Somerset County MC Only		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3928	001	0	1	01	01	H3928_001_0	2	1				08/01/2018	2019.01	08/01/2018 02:01:50 PM Eastern Daylight Time	08/02/2018 11:44:56 AM Eastern Daylight Time	07/31/2018 11:04:04 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH, INC. (LA)	Coventry Health Care	www.coventry-medicare.com	Advantra (HMO)	01	01		1			H3928	001	0	2019	New Orleans - Baton Rouge Metro Parishes		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)360-6626		(888)360-6626		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	002	0	1	01	01	H3928_002_0	2	1				05/30/2018	2019.01	05/30/2018 08:54:26 PM Eastern Daylight Time	08/02/2018 11:45:39 AM Eastern Daylight Time	07/31/2018 11:04:52 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH, INC. (LA)	Coventry Health Care	www.coventry-medicare.com	Advantra (HMO)	01	01		1			H3928	002	0	2019	Bossier, Caddo and St. Tammany Parishes		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(888)360-6626		(888)360-6626		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	801	0	1	01	01	H3928_801_0	3	1				06/04/2018	2019.01	06/04/2018 11:56:15 AM Eastern Daylight Time					06/04/2018 12:11:45 PM Eastern Daylight Time	AETNA HEALTH, INC. (LA)	Coventry Health Care	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	801	0	2019	Louisiana - Employer Group Plan CYD with RX		1	120	2			2						http://www.PharmacyLocator.coventry-medicare.com	http//www.LAformulary.coventry-medicare.com	http//www.ProviderDirectory.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)338-7027		(855)338-7027		(844)741-8423		(844)741-8423		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H3928	803	0	1	01	01	H3928_803_0	3	1				06/04/2018	2019.01	06/04/2018 11:49:21 AM Eastern Daylight Time					06/04/2018 12:11:45 PM Eastern Daylight Time	AETNA HEALTH, INC. (LA)	Coventry Health Care	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	803	0	2019	Louisiana Employer Group CYD No RX		1	120	2			2						http://www.PharmacyLocator.coventry-medicare.com	http//LAformulary.coventry-medicare.com	http://www.ProviderDirectory.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H3930	001	0	1	01	01	H3930_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:43:30 AM Eastern Daylight Time	08/07/2018 02:52:03 PM Eastern Daylight Time	08/07/2018 02:52:03 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN NY, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan I-SNP (HMO SNP)	01	01		1			H3930	001	0	2019	New York (partial)		2	722	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3930	002	0	1	01	01	H3930_002_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:44:30 AM Eastern Daylight Time	08/07/2018 02:52:03 PM Eastern Daylight Time	08/07/2018 02:52:03 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN NY, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan C-SNP (HMO SNP)	01	01		1			H3930	002	0	2019	New York (partial)		2	910	2			1	4			00000100000000000000		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3930	003	0	1	01	01	H3930_003_0	4	1				08/03/2018	2019.01	08/03/2018 09:45:22 AM Eastern Daylight Time	08/07/2018 02:52:04 PM Eastern Daylight Time	08/07/2018 02:52:04 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN NY, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO)	01	01		1			H3930	003	0	2019	New York (partial)		2	508	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3930	004	0	1	01	01	H3930_004_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:45:53 AM Eastern Daylight Time	08/07/2018 02:52:04 PM Eastern Daylight Time	08/07/2018 02:52:04 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN NY, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan Gold (HMO SNP)	01	01		1			H3930	004	0	2019	New York (partial)		2	536	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	004	0	1	01	01	H3931_004_0	3	1				07/11/2018	2019.01	07/11/2018 11:48:30 AM Eastern Daylight Time	08/02/2018 07:24:47 PM Eastern Daylight Time	07/31/2018 11:06:30 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3931	004	0	2019	Southeast Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	055	0	1	01	01	H3931_055_0	3	1				07/11/2018	2019.01	07/11/2018 11:15:58 AM Eastern Daylight Time	05/29/2018 03:37:52 PM Eastern Daylight Time				07/11/2018 04:56:22 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H3931	055	0	2019	Southeast Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3931	064	0	1	01	01	H3931_064_0	3	1				07/11/2018	2019.01	07/11/2018 11:16:48 AM Eastern Daylight Time	08/02/2018 07:26:03 PM Eastern Daylight Time	07/31/2018 11:07:22 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	064	0	2019	Southeast Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	070	0	1	01	01	H3931_070_0	3	1				07/11/2018	2019.01	07/11/2018 11:17:24 AM Eastern Daylight Time	08/02/2018 07:27:10 PM Eastern Daylight Time	07/31/2018 11:08:14 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver Plan (HMO)	01	01		1			H3931	070	0	2019	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	081	0	1	01	01	H3931_081_0	4	1				08/02/2018	2019.01	08/02/2018 10:50:29 AM Eastern Daylight Time	08/02/2018 12:33:53 PM Eastern Daylight Time	07/31/2018 11:05:42 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	081	0	2019	Raleigh/Charlotte and Surrounding Area		2	31500	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	091	0	1	01	01	H3931_091_0	3	1				08/02/2018	2019.01	08/02/2018 03:10:05 PM Eastern Daylight Time	08/02/2018 07:28:08 PM Eastern Daylight Time	07/31/2018 11:09:04 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PinnacleHealth Prime Plan (HMO)	01	01		1			H3931	091	0	2019	Cumberland and Dauphin counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	092	0	1	01	01	H3931_092_0	3	1				08/02/2018	2019.01	08/02/2018 08:18:27 AM Pacific Daylight Time	08/02/2018 02:31:14 PM Eastern Daylight Time	07/31/2018 05:49:24 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	092	0	2019	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	093	0	1	01	01	H3931_093_0	3	1				08/02/2018	2019.01	08/02/2018 06:19:13 AM Central Daylight Time	08/02/2018 04:35:36 PM Eastern Daylight Time	07/31/2018 05:50:04 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	093	0	2019	Denver and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	094	0	1	01	01	H3931_094_0	3	1				08/01/2018	2019.01	08/01/2018 01:09:59 PM Pacific Daylight Time	08/02/2018 03:01:31 PM Eastern Daylight Time	07/31/2018 05:50:44 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	094	0	2019	Clark County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	095	0	1	01	01	H3931_095_0	3	1				07/11/2018	2019.01	07/11/2018 11:18:33 AM Eastern Daylight Time	08/02/2018 12:04:22 PM Eastern Daylight Time	07/31/2018 11:09:56 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	095	0	2019	District of Columbia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	096	0	1	01	01	H3931_096_0	3	1				07/11/2018	2019.01	07/11/2018 11:18:59 AM Eastern Daylight Time	08/02/2018 12:05:24 PM Eastern Daylight Time	07/31/2018 11:10:48 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	096	0	2019	Fairfax County and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	097	0	1	01	01	H3931_097_0	3	1				07/11/2018	2019.01	07/11/2018 11:19:48 AM Eastern Daylight Time	08/02/2018 12:06:25 PM Eastern Daylight Time	07/31/2018 11:11:40 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	01	01		1			H3931	097	0	2019	Southern Maryland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	098	0	1	01	01	H3931_098_0	3	1				08/02/2018	2019.01	08/02/2018 09:13:06 AM Eastern Daylight Time	08/02/2018 12:07:23 PM Eastern Daylight Time	07/31/2018 11:12:32 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	098	0	2019	Richmond and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	099	0	1	01	01	H3931_099_0	3	1				08/02/2018	2019.01	08/02/2018 09:13:21 AM Eastern Daylight Time	08/02/2018 12:08:23 PM Eastern Daylight Time	07/31/2018 11:13:22 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	099	0	2019	Danville and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	100	0	1	01	01	H3931_100_0	3	1				08/02/2018	2019.01	08/02/2018 09:13:45 AM Eastern Daylight Time	08/02/2018 12:09:23 PM Eastern Daylight Time	07/31/2018 11:14:14 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	100	0	2019	Newport News and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	101	0	1	01	01	H3931_101_0	3	1				08/02/2018	2019.01	08/02/2018 09:14:03 AM Eastern Daylight Time	08/02/2018 12:10:22 PM Eastern Daylight Time	07/31/2018 11:15:06 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	101	0	2019	Roanoke and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	102	0	1	01	01	H3931_102_0	3	1				07/11/2018	2019.01	07/11/2018 11:22:49 AM Eastern Daylight Time	08/02/2018 07:29:01 PM Eastern Daylight Time	07/31/2018 11:15:56 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	102	0	2019	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	104	0	1	01	01	H3931_104_0	3	1				08/02/2018	2019.01	08/02/2018 09:24:42 AM Eastern Daylight Time	08/02/2018 07:29:58 PM Eastern Daylight Time	07/31/2018 11:16:48 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (HMO)	01	01		1			H3931	104	0	2019	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	105	0	1	01	01	H3931_105_0	3	1				08/02/2018	2019.01	08/02/2018 09:26:28 AM Eastern Daylight Time	08/02/2018 07:30:49 PM Eastern Daylight Time	07/31/2018 11:17:42 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Main Line Health Prime Plan (HMO)	01	01		1			H3931	105	0	2019	Chester, Delaware and Montgomery counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	106	0	1	01	01	H3931_106_0	3	1				08/02/2018	2019.01	08/02/2018 10:13:11 AM Eastern Daylight Time	08/02/2018 02:10:22 PM Eastern Daylight Time	07/31/2018 05:51:23 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	106	0	2019	Chicagoland		2	17448	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	107	0	1	01	01	H3931_107_0	3	1				08/02/2018	2019.01	08/02/2018 11:02:13 AM Eastern Daylight Time	08/02/2018 02:58:54 PM Eastern Daylight Time	07/31/2018 11:18:34 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	107	0	2019	Northeastern/Youngstown OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	108	0	1	01	01	H3931_108_0	3	1				08/02/2018	2019.01	08/02/2018 11:03:32 AM Eastern Daylight Time	08/02/2018 02:59:29 PM Eastern Daylight Time	07/31/2018 11:19:28 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	108	0	2019	Central OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	109	0	1	01	01	H3931_109_0	3	1				08/02/2018	2019.01	08/02/2018 11:03:49 AM Eastern Daylight Time	08/02/2018 03:00:06 PM Eastern Daylight Time	07/31/2018 11:20:20 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	109	0	2019	Toledo and Cincinnati OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	110	0	1	01	01	H3931_110_0	3	1				08/02/2018	2019.01	08/02/2018 11:04:09 AM Eastern Daylight Time	08/02/2018 03:00:41 PM Eastern Daylight Time	07/31/2018 11:21:10 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	110	0	2019	Dayton OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	112	0	1	01	01	H3931_112_0	3	1				08/02/2018	2019.01	08/02/2018 09:27:38 AM Eastern Daylight Time	08/02/2018 07:31:40 PM Eastern Daylight Time	07/31/2018 11:22:02 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (HMO)	01	01		1			H3931	112	0	2019	Southeastern and Central PA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	115	0	1	01	01	H3931_115_0	3	1				08/01/2018	2019.01	08/01/2018 01:11:39 PM Pacific Daylight Time	08/02/2018 03:03:05 PM Eastern Daylight Time	07/31/2018 05:52:02 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	01	01		1			H3931	115	0	2019	Washoe, Carson City and Douglas County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	118	0	1	01	01	H3931_118_0	3	1				08/02/2018	2019.01	08/02/2018 11:04:30 AM Eastern Daylight Time	08/02/2018 03:01:17 PM Eastern Daylight Time	07/31/2018 11:22:56 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	118	0	2019	Lexington KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	122	0	1	01	01	H3931_122_0	3	1				08/01/2018	2019.01	08/01/2018 04:03:32 PM Eastern Daylight Time	08/03/2018 10:14:26 AM Central Daylight Time	07/31/2018 10:05:36 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	122	0	2019	Eastern MA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	123	0	1	01	01	H3931_123_0	3	1				08/01/2018	2019.01	08/01/2018 04:03:51 PM Eastern Daylight Time	08/03/2018 10:15:06 AM Central Daylight Time	07/31/2018 10:06:26 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	123	0	2019	Central MA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	124	0	1	01	01	H3931_124_0	3	1				08/02/2018	2019.01	08/02/2018 09:14:23 AM Eastern Daylight Time	08/02/2018 12:11:23 PM Eastern Daylight Time	07/31/2018 11:23:50 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare UVA Health System Prime Plan (HMO)	01	01		1			H3931	124	0	2019	Charlottesville and Surrounding area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	125	0	1	01	01	H3931_125_0	3	1				08/02/2018	2019.01	08/02/2018 11:50:26 AM Eastern Daylight Time	08/02/2018 11:46:21 AM Eastern Daylight Time	07/31/2018 11:06:36 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	125	0	2019	Central and Southwest Alabama Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	126	0	1	01	01	H3931_126_0	5	1				08/02/2018	2019.01	08/02/2018 11:48:10 AM Central Daylight Time	08/01/2018 02:59:38 PM Eastern Daylight Time	07/31/2018 05:52:42 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	126	0	2019	Greater Seattle Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	127	0	1	01	01	H3931_127_0	3	1				07/11/2018	2019.01	07/11/2018 11:29:18 AM Eastern Daylight Time	08/01/2018 03:05:09 PM Eastern Daylight Time	07/31/2018 05:53:22 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	01	01		1			H3931	127	0	2019	Greater Seattle Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	129	0	1	01	01	H3931_129_0	3	1				08/02/2018	2019.01	08/02/2018 06:59:40 AM Pacific Daylight Time	08/02/2018 03:40:28 PM Eastern Daylight Time	07/31/2018 05:54:03 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	01	01		1			H3931	129	0	2019	Pima and Pinal County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	130	0	1	01	01	H3931_130_0	3	1				08/01/2018	2019.01	08/01/2018 01:22:52 PM Pacific Daylight Time	08/02/2018 03:45:28 PM Eastern Daylight Time	07/31/2018 05:54:43 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	01	01		1			H3931	130	0	2019	Maricopa county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	131	0	1	01	01	H3931_131_0	3	1				07/11/2018	2019.01	07/11/2018 11:30:23 AM Eastern Daylight Time	08/02/2018 04:16:31 PM Eastern Daylight Time	07/31/2018 05:55:22 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	01	01		1			H3931	131	0	2019	Mohave, Yavapai and Gila counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	132	0	1	01	01	H3931_132_0	3	1				08/02/2018	2019.01	08/02/2018 03:59:41 PM Eastern Daylight Time	08/02/2018 03:01:53 PM Eastern Daylight Time	07/31/2018 11:24:42 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	132	0	2019	Toledo OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	133	0	1	01	01	H3931_133_0	3	1				08/02/2018	2019.01	08/02/2018 11:05:03 AM Eastern Daylight Time	08/02/2018 03:02:30 PM Eastern Daylight Time	07/31/2018 11:25:34 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	133	0	2019	Louisville KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	134	0	1	01	01	H3931_134_0	3	1				08/02/2018	2019.01	08/02/2018 11:05:31 AM Eastern Daylight Time	08/02/2018 03:03:06 PM Eastern Daylight Time	07/31/2018 11:26:28 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	134	0	2019	Bowling Green/Southwest KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	135	0	1	01	01	H3931_135_0	6	1				08/01/2018	2019.01	08/01/2018 04:04:18 PM Central Daylight Time	08/02/2018 03:04:37 PM Eastern Daylight Time	07/31/2018 05:56:05 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	135	0	2019	Southern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	https://www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	136	0	1	01	01	H3931_136_0	6	1				08/01/2018	2019.01	08/01/2018 04:04:54 PM Central Daylight Time	08/02/2018 03:05:27 PM Eastern Daylight Time	07/31/2018 05:56:48 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	136	0	2019	Northern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	https://www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	138	0	1	01	01	H3931_138_0	3	1				08/01/2018	2019.01	08/01/2018 12:09:57 PM Central Daylight Time	08/01/2018 03:06:19 PM Eastern Daylight Time	07/31/2018 05:57:29 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	138	0	2019	Spokane county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	139	0	1	01	01	H3931_139_0	3	1				07/11/2018	2019.01	07/11/2018 11:31:57 AM Eastern Daylight Time	08/01/2018 03:07:05 PM Eastern Daylight Time	07/31/2018 05:58:09 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	01	01		1			H3931	139	0	2019	Spokane county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	801	0	1	01	01	H3931_801_0	4	1				06/04/2018	2019.01	06/04/2018 10:55:48 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3931	801	0	2019	Pennsylvania		1	27920	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-1637		(888)267-1637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H3931	804	0	1	01	01	H3931_804_0	4	1				06/04/2018	2019.01	06/04/2018 10:57:12 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3931	804	0	2019	Pennsylvania		1	65450	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3942	001	0	1	20	08	H3942_001_0	1	1				05/23/2018	2019.01	05/23/2018 04:30:00 PM Eastern Daylight Time		05/23/2018 04:12:54 PM Eastern Daylight Time			05/23/2018 04:32:00 PM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	001	0	2019	Elderhaus PACE-New Hanover County		2	1486	2			2						www.elderhaus.com	www.elderhaus.com										(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209										(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209																
H3942	002	0	1	20	08	H3942_002_0	1	1				05/23/2018	2019.01	05/23/2018 04:30:03 PM Eastern Daylight Time		05/23/2018 04:13:13 PM Eastern Daylight Time			05/23/2018 04:32:00 PM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	002	0	2019	Elderhaus PACE-Brunswick County		2		2			2						www.elderhaus.com	www.elderhaus.com										(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209										(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209																
H3949	009	0	1	01	01	H3949_009_0	5	1	2	1		07/20/2018	2019.01	07/20/2018 03:46:20 PM Central Daylight Time	08/03/2018 08:54:57 AM Central Daylight Time	07/31/2018 08:20:06 PM Central Daylight Time			08/06/2018 12:12:14 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H3949	009	0	2019	Select Pennsylvania Counties		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	013	0	1	01	01	H3949_013_0	5	1				08/02/2018	2019.01	08/02/2018 05:31:27 PM Central Daylight Time	08/03/2018 08:55:18 AM Central Daylight Time	07/31/2018 08:20:19 PM Central Daylight Time			08/06/2018 12:12:14 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	01	01		1			H3949	013	0	2019	Select Pennsylvania Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	016	0	1	01	01	H3949_016_0	5	1		1		08/02/2018	2019.01	08/02/2018 05:31:50 PM Central Daylight Time	08/03/2018 08:55:40 AM Central Daylight Time	07/31/2018 08:20:34 PM Central Daylight Time			08/06/2018 12:12:14 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Traditions (HMO SNP)	01	01		1			H3949	016	0	2019	Select Pennsylvania Counties		2		2			1	1	1				www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	024	0	1	01	01	H3949_024_0	5	1		1		07/20/2018	2019.01	07/20/2018 03:46:56 PM Central Daylight Time	08/06/2018 11:17:42 AM Central Daylight Time	07/31/2018 08:20:48 PM Central Daylight Time			08/06/2018 12:12:14 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H3949	024	0	2019	Select Pennsylvania Counties		2		2			1	4			00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	026	0	1	01	01	H3949_026_0	4	1				07/20/2018	2019.01	07/20/2018 03:47:10 PM Central Daylight Time	07/16/2018 03:43:11 PM Central Daylight Time				07/21/2018 05:55:43 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H3949	026	0	2019	Select Pennsylvania Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3949	030	0	1	01	01	H3949_030_0	6	1				08/02/2018	2019.01	08/02/2018 05:32:07 PM Central Daylight Time	08/03/2018 08:56:44 AM Central Daylight Time	07/31/2018 09:00:21 PM Central Daylight Time			08/06/2018 12:12:14 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H3949	030	0	2019	Select Pennsylvania Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	031	0	1	01	01	H3949_031_0	5	1				08/02/2018	2019.01	08/02/2018 05:32:42 PM Central Daylight Time	08/03/2018 08:57:05 AM Central Daylight Time	07/31/2018 09:00:34 PM Central Daylight Time			08/06/2018 12:12:14 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Alliance (HMO)	01	01		1			H3949	031	0	2019	Select Pennsylvania Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	804	0	1	01	01	H3949_804_0	2	1				05/22/2018	2019.01	05/22/2018 02:09:11 PM Central Daylight Time					06/01/2018 11:11:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H3949	804	0	2019	Statewide PA		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14e1;15;16b;17a;	1	1a;3-1;3-2;3-3;7b;7d;9a1;9a2;12;14e3;	1					1				
H3949	806	0	1	02	01	H3949_806_0	2	1				05/22/2018	2019.01	05/22/2018 02:15:05 PM Central Daylight Time					06/01/2018 11:11:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H3949	806	0	2019	Statewide PA		1	36	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14e1;15;16b;17a;	1	1a;3-1;3-2;3-3;7b;7d;9a1;9a2;12;14e3;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14e1;15;16b;17a;	2		1				
H3952	008	0	1	01	01	H3952_008_0	2	1			1	07/12/2018	2019.01	07/12/2018 06:01:45 PM Eastern Daylight Time	06/02/2018 01:13:50 PM Eastern Daylight Time				07/12/2018 07:57:23 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	008	0	2019	Bucks, Philadelphia Counties		2	15366	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7a;	
H3952	020	0	1	01	01	H3952_020_0	3	1			1	07/26/2018	2019.01	07/26/2018 02:15:02 PM Eastern Daylight Time	08/03/2018 04:33:58 PM Eastern Daylight Time	08/02/2018 09:47:40 AM Eastern Daylight Time			08/03/2018 04:52:41 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	020	0	2019	Bucks, Philadelphia Counties		2	74513	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	044	0	1	01	01	H3952_044_0	2	1			1	07/12/2018	2019.01	07/12/2018 06:08:58 PM Eastern Daylight Time	06/02/2018 01:13:57 PM Eastern Daylight Time				07/12/2018 07:57:23 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	044	0	2019	Chester, Delaware, Montgomery Counties		2	7609	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7a;	
H3952	045	0	1	01	01	H3952_045_0	3	1			1	07/12/2018	2019.01	07/12/2018 06:11:39 PM Eastern Daylight Time	08/03/2018 04:36:44 PM Eastern Daylight Time	08/02/2018 09:47:42 AM Eastern Daylight Time			08/03/2018 04:52:41 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	045	0	2019	Chester, Delaware, Montgomery Counties		2	43356	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	048	0	1	01	01	H3952_048_0	2	1			1	07/12/2018	2019.01	07/12/2018 06:14:30 PM Eastern Daylight Time	06/02/2018 01:14:04 PM Eastern Daylight Time				07/12/2018 08:00:04 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	048	0	2019	Bucks, Philadelphia Counties		2	23348	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7a;	
H3952	049	0	1	01	01	H3952_049_0	3	1			1	07/12/2018	2019.01	07/12/2018 06:17:02 PM Eastern Daylight Time	08/03/2018 09:56:30 AM Eastern Daylight Time	08/02/2018 09:47:44 AM Eastern Daylight Time			08/03/2018 04:22:50 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	049	0	2019	Bucks, Philadelphia Counties		2	243249	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	050	0	1	01	01	H3952_050_0	2	1			1	07/12/2018	2019.01	07/12/2018 06:19:11 PM Eastern Daylight Time	06/02/2018 01:14:12 PM Eastern Daylight Time				07/12/2018 08:00:04 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	050	0	2019	Chester, Delaware, Montgomery Counties		2	23467	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7a;	
H3952	051	0	1	01	01	H3952_051_0	8	1			1	07/12/2018	2019.01	07/12/2018 06:30:13 PM Eastern Daylight Time	08/03/2018 09:54:28 AM Eastern Daylight Time	08/02/2018 09:47:48 AM Eastern Daylight Time			08/03/2018 04:22:50 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	051	0	2019	Chester, Delaware, Montgomery Counties		2	166104	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	053	0	1	02	01	H3952_053_0	3	1			2	08/03/2018	2019.01	08/03/2018 03:45:33 PM Eastern Daylight Time	08/03/2018 09:23:00 AM Eastern Daylight Time	08/02/2018 09:47:54 AM Eastern Daylight Time			08/03/2018 04:36:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO-POS)	01	02		1			H3952	053	0	2019	Philadelphia, Bucks		2	177364	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	054	0	1	02	01	H3952_054_0	3	1			2	07/12/2018	2019.01	07/12/2018 06:35:18 PM Eastern Daylight Time	08/03/2018 09:26:32 AM Eastern Daylight Time	08/02/2018 09:47:58 AM Eastern Daylight Time			08/03/2018 04:36:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO-POS)	01	02		1			H3952	054	0	2019	Chester, Delaware, Montgomery		2	92492	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	055	0	1	01	01	H3952_055_0	3	1			2	07/12/2018	2019.01	07/12/2018 06:38:05 PM Eastern Daylight Time	08/03/2018 11:21:38 AM Eastern Daylight Time	08/02/2018 09:48:00 AM Eastern Daylight Time			08/03/2018 04:42:31 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Basic Rx (HMO)	01	01		1			H3952	055	0	2019	Philadelphia, Bucks		2	102269	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	056	0	1	01	01	H3952_056_0	3	1			2	07/12/2018	2019.01	07/12/2018 07:37:20 PM Eastern Daylight Time	08/03/2018 11:36:18 AM Eastern Daylight Time	08/02/2018 09:48:02 AM Eastern Daylight Time			08/03/2018 04:42:31 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Basic Rx (HMO)	01	01		1			H3952	056	0	2019	Chester, Delaware, Montgomery		2	93883	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H3952	802	0	1	01	01	H3952_802_0	1	1				05/31/2018	2019.01	05/31/2018 04:05:59 PM Eastern Daylight Time					06/02/2018 09:11:11 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Medical Only (HMO)	01	01		1			H3952	802	0	2019	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	16150	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1					1				
H3952	804	0	1	01	01	H3952_804_0	1	1				05/31/2018	2019.01	05/31/2018 04:07:29 PM Eastern Daylight Time					06/02/2018 09:13:02 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Rx (HMO)	01	01		1			H3952	804	0	2019	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	31970	2			2						www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1					1				
H3954	097	0	1	01	01	H3954_097_0	5	1	2	1		07/26/2018	2019.01	07/26/2018 12:29:06 PM Eastern Daylight Time	08/06/2018 12:06:01 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Secure Rx (HMO SNP)	01	01		1			H3954	097	0	2019	Pennsylvania		2		2			1	3		2		1	www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	156	10	1	01	01	H3954_156_10	2	1				06/01/2018	2019.01	06/01/2018 05:25:19 PM Eastern Daylight Time	06/02/2018 08:30:41 PM Eastern Daylight Time				06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	10	2019	Pennsylvania	Midwest	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	11	1	01	01	H3954_156_11	2	1				05/29/2018	2019.01	05/29/2018 03:34:15 PM Eastern Daylight Time	06/02/2018 08:31:39 PM Eastern Daylight Time				06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	11	2019	Pennsylvania	Bradford, Tioga	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	12	1	01	01	H3954_156_12	3	1				05/29/2018	2019.01	05/29/2018 03:34:15 PM Eastern Daylight Time	07/24/2018 03:29:54 PM Eastern Daylight Time				07/25/2018 09:07:16 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	12	2019	Pennsylvania	Lackawanna, Pike, Susquehanna, Wayne, Wyoming	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	13	1	01	01	H3954_156_13	2	1				05/29/2018	2019.01	05/29/2018 03:34:16 PM Eastern Daylight Time	06/02/2018 08:33:35 PM Eastern Daylight Time				06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	13	2019	Pennsylvania	Midstate	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	14	1	01	01	H3954_156_14	3	1				07/19/2018	2019.01	07/19/2018 12:25:22 PM Eastern Daylight Time	06/02/2018 08:34:33 PM Eastern Daylight Time				07/19/2018 05:36:50 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	14	2019	Pennsylvania	Central	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	15	1	01	01	H3954_156_15	2	1				05/29/2018	2019.01	05/29/2018 03:34:16 PM Eastern Daylight Time	06/02/2018 08:35:32 PM Eastern Daylight Time				06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	15	2019	Pennsylvania	Bucks, Carbon, Lehigh, Monroe, Northampton	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	16	1	01	01	H3954_156_16	2	1				05/29/2018	2019.01	05/29/2018 03:34:16 PM Eastern Daylight Time	06/02/2018 08:36:30 PM Eastern Daylight Time				06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	16	2019	Pennsylvania	Franklin	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	17	1	01	01	H3954_156_17	2	1				05/29/2018	2019.01	05/29/2018 03:34:16 PM Eastern Daylight Time	06/02/2018 08:37:28 PM Eastern Daylight Time				06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	17	2019	Pennsylvania	Berks, Cumberland, Dauphin, Lancaster, Perry	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	18	1	01	01	H3954_156_18	2	1				05/29/2018	2019.01	05/29/2018 03:34:17 PM Eastern Daylight Time	06/02/2018 08:38:27 PM Eastern Daylight Time				06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	18	2019	Pennsylvania	Adams, Lebanon, York	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	157	10	1	01	01	H3954_157_10	3	1				08/06/2018	2019.01	08/06/2018 11:58:49 AM Eastern Daylight Time	08/06/2018 12:06:03 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	10	2019	Pennsylvania	Midwest	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	11	1	01	01	H3954_157_11	3	1				08/06/2018	2019.01	08/06/2018 11:58:42 AM Eastern Daylight Time	08/06/2018 12:06:03 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	11	2019	Pennsylvania	Bradford, Tioga	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	12	1	01	01	H3954_157_12	4	1				08/06/2018	2019.01	08/06/2018 11:59:09 AM Eastern Daylight Time	08/06/2018 12:06:04 PM Eastern Daylight Time	08/06/2018 12:06:15 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	12	2019	Pennsylvania	Lackawanna, Pike, Susquehanna, Wayne, Wyoming	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	13	1	01	01	H3954_157_13	3	1				08/06/2018	2019.01	08/06/2018 11:59:20 AM Eastern Daylight Time	08/06/2018 12:06:04 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	13	2019	Pennsylvania	Midstate	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	14	1	01	01	H3954_157_14	4	1				08/06/2018	2019.01	08/06/2018 11:59:31 AM Eastern Daylight Time	08/06/2018 12:06:04 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	14	2019	Pennsylvania	Central	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	15	1	01	01	H3954_157_15	3	1				08/06/2018	2019.01	08/06/2018 11:59:41 AM Eastern Daylight Time	08/06/2018 12:06:04 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	15	2019	Pennsylvania	Bucks, Carbon, Lehigh, Monroe, Northampton	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	16	1	01	01	H3954_157_16	3	1				08/06/2018	2019.01	08/06/2018 11:59:52 AM Eastern Daylight Time	08/06/2018 12:06:04 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	16	2019	Pennsylvania	Franklin	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	17	1	01	01	H3954_157_17	3	1				08/06/2018	2019.01	08/06/2018 12:00:04 PM Eastern Daylight Time	08/06/2018 12:06:05 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	17	2019	Pennsylvania	Berks, Cumberland, Dauphin, Lancaster, Perry	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	18	1	01	01	H3954_157_18	3	1				08/06/2018	2019.01	08/06/2018 12:00:14 PM Eastern Daylight Time	08/06/2018 12:06:05 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	18	2019	Pennsylvania	Adams, Lebanon, York	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	10	1	01	01	H3954_158_10	3	1				08/06/2018	2019.01	08/06/2018 12:00:42 PM Eastern Daylight Time	08/06/2018 12:06:05 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	10	2019	Pennsylvania	Midwest	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	11	1	01	01	H3954_158_11	3	1				08/06/2018	2019.01	08/06/2018 12:01:31 PM Eastern Daylight Time	08/06/2018 12:06:05 PM Eastern Daylight Time	08/06/2018 12:06:16 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	11	2019	Pennsylvania	Bradford, Tioga	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	12	1	01	01	H3954_158_12	3	1				08/06/2018	2019.01	08/06/2018 12:01:39 PM Eastern Daylight Time	08/06/2018 12:06:05 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	12	2019	Pennsylvania	Lackawanna, Pike, Susquehanna, Wayne, Wyoming	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	13	1	01	01	H3954_158_13	3	1				08/06/2018	2019.01	08/06/2018 12:01:48 PM Eastern Daylight Time	08/06/2018 12:06:05 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	13	2019	Pennsylvania	Midstate	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	14	1	01	01	H3954_158_14	4	1				08/06/2018	2019.01	08/06/2018 12:01:55 PM Eastern Daylight Time	08/06/2018 12:06:06 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	14	2019	Pennsylvania	Central	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	15	1	01	01	H3954_158_15	3	1				08/06/2018	2019.01	08/06/2018 12:02:03 PM Eastern Daylight Time	08/06/2018 12:06:06 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	15	2019	Pennsylvania	Bucks, Carbon, Lehigh, Monroe, Northampton	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	16	1	01	01	H3954_158_16	3	1				08/06/2018	2019.01	08/06/2018 12:02:14 PM Eastern Daylight Time	08/06/2018 12:06:06 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	16	2019	Pennsylvania	Franklin	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	17	1	01	01	H3954_158_17	3	1				08/06/2018	2019.01	08/06/2018 12:02:21 PM Eastern Daylight Time	08/06/2018 12:06:06 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	17	2019	Pennsylvania	Berks, Cumberland, Dauphin, Lancaster, Perry	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	18	1	01	01	H3954_158_18	3	1				08/06/2018	2019.01	08/06/2018 12:02:27 PM Eastern Daylight Time	08/06/2018 12:06:06 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	18	2019	Pennsylvania	Adams, Lebanon, York	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	10	1	01	01	H3954_159_10	3	1				08/06/2018	2019.01	08/06/2018 12:02:49 PM Eastern Daylight Time	08/06/2018 12:06:06 PM Eastern Daylight Time	08/06/2018 12:06:17 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	10	2019	Pennsylvania	Midwest	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	11	1	01	01	H3954_159_11	3	1				08/06/2018	2019.01	08/06/2018 12:03:41 PM Eastern Daylight Time	08/06/2018 12:06:07 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	11	2019	Pennsylvania	Bradford, Tioga	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	12	1	01	01	H3954_159_12	3	1				08/06/2018	2019.01	08/06/2018 12:03:47 PM Eastern Daylight Time	08/06/2018 12:06:07 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	12	2019	Pennsylvania	Lackawanna, Pike, Susquehanna, Wayne, Wyoming	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	13	1	01	01	H3954_159_13	3	1				08/06/2018	2019.01	08/06/2018 12:03:54 PM Eastern Daylight Time	08/06/2018 12:06:07 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	13	2019	Pennsylvania	Midstate	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	14	1	01	01	H3954_159_14	3	1				08/06/2018	2019.01	08/06/2018 12:04:04 PM Eastern Daylight Time	08/06/2018 12:06:07 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	14	2019	Pennsylvania	Central	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	15	1	01	01	H3954_159_15	3	1				08/06/2018	2019.01	08/06/2018 12:04:13 PM Eastern Daylight Time	08/06/2018 12:06:07 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	15	2019	Pennsylvania	Bucks, Carbon, Lehigh, Monroe, Northampton	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	16	1	01	01	H3954_159_16	3	1				08/06/2018	2019.01	08/06/2018 12:04:22 PM Eastern Daylight Time	08/06/2018 12:06:07 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	16	2019	Pennsylvania	Franklin	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	17	1	01	01	H3954_159_17	3	1				08/06/2018	2019.01	08/06/2018 12:04:29 PM Eastern Daylight Time	08/06/2018 12:06:08 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	17	2019	Pennsylvania	Berks, Cumberland, Dauphin, Lancaster, Perry	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	18	1	01	01	H3954_159_18	3	1				08/06/2018	2019.01	08/06/2018 12:04:37 PM Eastern Daylight Time	08/06/2018 12:06:08 PM Eastern Daylight Time	08/06/2018 12:06:18 PM Eastern Daylight Time			08/06/2018 04:06:22 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	159	18	2019	Pennsylvania	Adams, Lebanon, York	2		2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	801	0	1	01	01	H3954_801_0	2	1				04/23/2018	2019.01	04/23/2018 09:21:34 PM Eastern Daylight Time					06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic (Employer Group) (HMO)	01	01		1			H3954	801	0	2019	Pennsylvania		1	67061	2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	802	0	1	01	01	H3954_802_0	2	1				04/23/2018	2019.01	04/23/2018 09:24:56 PM Eastern Daylight Time					06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Rx (Employer Group) (HMO)	01	01		1			H3954	802	0	2019	Pennsylvania		1	9529	2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	805	0	1	01	01	H3954_805_0	2	1				04/23/2018	2019.01	04/23/2018 09:28:05 PM Eastern Daylight Time					06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Rx EGWP New Jersey (HMO)	01	01		1			H3954	805	0	2019	Monmouth & Ocean Counties, NJ		1	600	2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	003	0	1	02	01	H3957_003_0	6	1			2	07/05/2018	2019.01	07/05/2018 09:17:56 AM Eastern Daylight Time	08/01/2018 08:52:13 PM Eastern Daylight Time	08/01/2018 11:33:53 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS Standard (HMO-POS)	01	02		1			H3957	003	0	2019	Southwestern PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	006	0	1	02	01	H3957_006_0	6	1			2	05/21/2018	2019.01	05/21/2018 02:25:57 PM Eastern Daylight Time	08/01/2018 08:52:42 PM Eastern Daylight Time	08/01/2018 11:32:15 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS Standard (HMO-POS)	01	02		1			H3957	006	0	2019	West Central PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	020	0	1	02	01	H3957_020_0	6	1			2	05/21/2018	2019.01	05/21/2018 02:24:47 PM Eastern Daylight Time	08/01/2018 08:53:11 PM Eastern Daylight Time	08/01/2018 11:30:31 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS Deluxe (HMO-POS)	01	02		1			H3957	020	0	2019	Southwestern PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	021	0	1	02	01	H3957_021_0	6	1			2	05/21/2018	2019.01	05/21/2018 02:26:10 PM Eastern Daylight Time	08/01/2018 08:53:40 PM Eastern Daylight Time	08/01/2018 11:28:15 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS Deluxe (HMO-POS)	01	02		1			H3957	021	0	2019	West Central PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	024	0	1	02	01	H3957_024_0	5	1			2	05/16/2018	2019.01	05/16/2018 11:23:25 AM Eastern Daylight Time	06/03/2018 02:31:32 PM Eastern Daylight Time				06/04/2018 08:56:06 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS Basic (HMO-POS)	01	02		1			H3957	024	0	2019	Southwestern PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3957	025	0	1	02	01	H3957_025_0	5	1			2	05/16/2018	2019.01	05/16/2018 11:23:36 AM Eastern Daylight Time	06/03/2018 02:32:05 PM Eastern Daylight Time				06/04/2018 08:56:06 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS Basic (HMO-POS)	01	02		1			H3957	025	0	2019	West Central PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3957	031	0	1	02	01	H3957_031_0	7	1			1	07/12/2018	2019.01	07/12/2018 02:05:18 PM Eastern Daylight Time	08/03/2018 08:13:36 AM Eastern Daylight Time	08/01/2018 11:26:49 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	031	0	2019	Southwestern PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	032	0	1	02	01	H3957_032_0	6	1			2	05/21/2018	2019.01	05/21/2018 02:29:34 PM Eastern Daylight Time	08/01/2018 08:55:45 PM Eastern Daylight Time	08/01/2018 11:19:41 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	032	0	2019	West Central PA		2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	038	0	1	01	01	H3957_038_0	6	1			2	05/23/2018	2019.01	05/23/2018 01:31:24 PM Eastern Daylight Time	08/01/2018 08:56:14 PM Eastern Daylight Time	08/01/2018 11:18:00 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	038	0	2019	Western PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	039	0	1	01	01	H3957_039_0	6	1			2	05/18/2018	2019.01	05/18/2018 01:57:26 PM Eastern Daylight Time	08/01/2018 08:56:44 PM Eastern Daylight Time	08/01/2018 11:15:41 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Prestige (HMO)	01	01		1			H3957	039	0	2019	Western PA		2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	042	1	1	01	01	H3957_042_1	8	1			2	06/29/2018	2019.01	06/29/2018 06:53:11 AM Eastern Daylight Time	08/01/2018 08:57:12 PM Eastern Daylight Time	08/01/2018 11:07:21 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	1	2019	North Central	Lehigh Valley	2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	042	2	1	01	01	H3957_042_2	8	1			2	06/29/2018	2019.01	06/29/2018 06:54:19 AM Eastern Daylight Time	08/01/2018 08:57:44 PM Eastern Daylight Time	08/01/2018 11:09:10 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	2	2019	North Central	Harrisburg	2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	042	4	1	01	01	H3957_042_4	6	1			2	06/29/2018	2019.01	06/29/2018 06:52:31 AM Eastern Daylight Time	08/01/2018 08:58:16 PM Eastern Daylight Time	08/01/2018 11:10:41 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	4	2019	North Central	North Central	2		2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	042	5	1	01	01	H3957_042_5	6	1			2	06/29/2018	2019.01	06/29/2018 06:53:24 AM Eastern Daylight Time	08/01/2018 08:58:44 PM Eastern Daylight Time	08/01/2018 11:12:55 AM Eastern Daylight Time			08/03/2018 09:06:01 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	5	2019	North Central	Lancaster	2	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	805	0	1	01	01	H3957_805_0	4	1				05/16/2018	2019.01	05/16/2018 10:52:34 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO MA (HMO)	01	01		1			H3957	805	0	2019	Western PA		1	17808	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					1				
H3957	806	0	1	01	01	H3957_806_0	4	1				05/16/2018	2019.01	05/16/2018 10:53:16 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO MA-PD (HMO)	01	01		1			H3957	806	0	2019	Western PA		1	8472	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					1				
H3957	808	0	1	01	01	H3957_808_0	4	1				05/16/2018	2019.01	05/16/2018 10:53:45 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO MA-PD Non-Calendar (HMO)	01	01		1			H3957	808	0	2019	Western PA		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					1				
H3957	810	0	1	01	01	H3957_810_0	4	1				05/16/2018	2019.01	05/16/2018 10:54:07 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO MA (HMO)	01	01		1			H3957	810	0	2019	Pennsylvania (Western and North Central)		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					1				
H3957	811	0	1	01	01	H3957_811_0	4	1				05/16/2018	2019.01	05/16/2018 10:54:25 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO MA-PD (HMO)	01	01		1			H3957	811	0	2019	Pennsylvania (Western and North Central)		1	1980	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					1				
H3957	812	0	1	01	01	H3957_812_0	4	1				05/16/2018	2019.01	05/16/2018 10:54:43 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO MA-PD Non-Calendar (HMO)	01	01		1			H3957	812	0	2019	Pennsylvania (Western and North Central)		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					1				
H3957	813	0	1	02	01	H3957_813_0	4	1				05/16/2018	2019.01	05/16/2018 10:59:07 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS MA (HMO-POS)	01	02		1			H3957	813	0	2019	Western PA		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;3-1;3-2;3-3;5;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;17a;18a;	2		1				
H3957	814	0	1	02	01	H3957_814_0	4	1				05/16/2018	2019.01	05/16/2018 11:01:44 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS MA-PD (HMO-POS)	01	02		1			H3957	814	0	2019	Western PA		1	120000	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;3-1;3-2;3-3;5;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;17a;18a;	2		1				
H3957	815	0	1	02	01	H3957_815_0	4	1				05/16/2018	2019.01	05/16/2018 11:01:25 AM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO-POS MA-PD Non-Calendar (HMO-POS)	01	02		1			H3957	815	0	2019	Western PA		1	0	2			2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;3-1;3-2;3-3;5;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;17a;18a;	2		1				
H3959	001	0	1	01	01	H3959_001_0	3	1			1	06/26/2018	2019.01	06/26/2018 09:13:23 AM Eastern Daylight Time	08/02/2018 06:27:44 PM Eastern Daylight Time	07/31/2018 11:27:20 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Gold (HMO)	01	01		1			H3959	001	0	2019	Allegheny County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	002	0	1	01	01	H3959_002_0	3	1			1	06/26/2018	2019.01	06/26/2018 09:14:03 AM Eastern Daylight Time	08/02/2018 06:29:28 PM Eastern Daylight Time	07/31/2018 11:28:12 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Gold (HMO)	01	01		1			H3959	002	0	2019	Western Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	010	0	1	01	01	H3959_010_0	2	1			2	08/01/2018	2019.01	08/01/2018 06:46:14 PM Eastern Daylight Time	08/02/2018 06:32:35 PM Eastern Daylight Time	07/31/2018 11:29:04 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (HMO)	01	01		1			H3959	010	0	2019	Allegheny County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	011	0	1	01	01	H3959_011_0	5	1			2	08/01/2018	2019.01	08/01/2018 06:47:03 PM Eastern Daylight Time	08/02/2018 06:35:32 PM Eastern Daylight Time	07/31/2018 11:29:54 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (HMO)	01	01		1			H3959	011	0	2019	Western Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	032	0	1	01	01	H3959_032_0	3	1			2	08/02/2018	2019.01	08/02/2018 09:38:17 AM Eastern Daylight Time	08/02/2018 06:36:58 PM Eastern Daylight Time	07/31/2018 11:30:44 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Silver Plus (HMO)	01	01		1			H3959	032	0	2019	Northwestern Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	033	0	1	01	01	H3959_033_0	2	1			2	08/02/2018	2019.01	08/02/2018 09:41:09 AM Eastern Daylight Time	08/02/2018 07:14:03 PM Eastern Daylight Time	07/31/2018 11:31:36 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (HMO)	01	01		1			H3959	033	0	2019	Southeastern Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	035	0	1	01	01	H3959_035_0	3	1	2	1	2	08/02/2018	2019.01	08/02/2018 06:31:35 PM Eastern Daylight Time	08/02/2018 07:13:03 PM Eastern Daylight Time	07/31/2018 11:32:26 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Cares (HMO SNP)	01	01		1			H3959	035	0	2019	Southeastern Pennsylvania		2		2			1	3		2		2	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	036	0	1	01	01	H3959_036_0	4	1	2	1	2	08/02/2018	2019.01	08/02/2018 04:33:00 PM Eastern Daylight Time	08/02/2018 07:12:00 PM Eastern Daylight Time	08/03/2018 03:26:26 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Cares (HMO SNP)	01	01		1			H3959	036	0	2019	Central and Western Pennsylvania		2		2			1	3		2		2	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	037	0	1	01	01	H3959_037_0	2	1			2	08/02/2018	2019.01	08/02/2018 09:43:03 AM Eastern Daylight Time	08/02/2018 07:11:08 PM Eastern Daylight Time	07/31/2018 11:34:12 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Northern Pennsylvania Gold (HMO)	01	01		1			H3959	037	0	2019	Northeastern Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	039	0	1	01	01	H3959_039_0	2	1			2	08/02/2018	2019.01	08/02/2018 03:05:03 PM Eastern Daylight Time	08/02/2018 07:10:12 PM Eastern Daylight Time	07/31/2018 11:35:04 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Silver Plus (HMO)	01	01		1			H3959	039	0	2019	Central Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	041	0	1	01	01	H3959_041_0	2	1			2	05/24/2018	2019.01	05/24/2018 10:28:04 AM Eastern Daylight Time	05/29/2018 03:52:41 PM Eastern Daylight Time				05/31/2018 02:05:34 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Basic Medical (HMO)	01	01		1			H3959	041	0	2019	Central and Western Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3959	043	0	1	01	01	H3959_043_0	2	1			2	08/01/2018	2019.01	08/01/2018 06:52:57 PM Eastern Daylight Time	08/02/2018 07:09:14 PM Eastern Daylight Time	07/31/2018 11:35:56 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Choice Plan (HMO)	01	01		1			H3959	043	0	2019	Allegheny County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	045	0	1	01	01	H3959_045_0	2	1			2	08/02/2018	2019.01	08/02/2018 03:14:24 PM Eastern Daylight Time	08/02/2018 07:08:03 PM Eastern Daylight Time	07/31/2018 11:36:50 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Penn Highlands Prime (HMO)	01	01		1			H3959	045	0	2019	Clearfield, Elk and Jefferson Counties		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	046	0	1	01	01	H3959_046_0	2	1			2	08/02/2018	2019.01	08/02/2018 03:16:50 PM Eastern Daylight Time	08/02/2018 07:06:26 PM Eastern Daylight Time	07/31/2018 11:37:42 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Washington Prime (HMO)	01	01		1			H3959	046	0	2019	Greene and Washington Counties		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	047	0	1	01	01	H3959_047_0	2	1			2	08/02/2018	2019.01	08/02/2018 03:18:08 PM Eastern Daylight Time	08/02/2018 07:05:23 PM Eastern Daylight Time	07/31/2018 11:38:36 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Butler Prime (HMO)	01	01		1			H3959	047	0	2019	Butler County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	049	0	1	01	01	H3959_049_0	2	1			2	08/02/2018	2019.01	08/02/2018 03:19:25 PM Eastern Daylight Time	08/02/2018 07:03:08 PM Eastern Daylight Time	07/31/2018 11:39:28 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Excela Prime (HMO)	01	01		1			H3959	049	0	2019	Westmoreland County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	051	0	1	01	01	H3959_051_0	2	1			2	08/02/2018	2019.01	08/02/2018 03:20:32 PM Eastern Daylight Time	08/02/2018 07:02:10 PM Eastern Daylight Time	07/31/2018 11:40:22 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Beaver Valley Prime (HMO)	01	01		1			H3959	051	0	2019	Beaver County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	052	0	1	01	01	H3959_052_0	2	1			2	08/02/2018	2019.01	08/02/2018 03:22:30 PM Eastern Daylight Time	08/02/2018 07:00:42 PM Eastern Daylight Time	07/31/2018 11:41:16 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	www.coventry-medicare.com	Advantra Southeast Prime (HMO)	01	01		1			H3959	052	0	2019	Southeastern Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	803	0	1	01	01	H3959_803_0	4	1				06/04/2018	2019.01	06/04/2018 10:57:53 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra MA Only (HMO)	01	01		1			H3959	803	0	2019	Pennsylvania		1	120	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3959	804	0	1	01	01	H3959_804_0	4	1				06/04/2018	2019.01	06/04/2018 10:58:45 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H3959	804	0	2019	Pennsylvania		1	30750	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888		(844)741-8423		(844)741-8423		(855)275-5888		(855)275-5888		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H3962	001	0	1	01	01	H3962_001_0	3	1				07/09/2018	2019.01	07/09/2018 02:22:35 PM Eastern Daylight Time	08/02/2018 01:57:28 PM Eastern Daylight Time	08/02/2018 01:58:46 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Premier (HMO)	01	01		1			H3962	001	0	2019	21 Counties in Central PA		2	46679	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	004	0	1	01	01	H3962_004_0	4	1				07/09/2018	2019.01	07/09/2018 02:24:47 PM Eastern Daylight Time	08/02/2018 02:00:14 PM Eastern Daylight Time	08/02/2018 02:01:12 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Value (HMO)	01	01		1			H3962	004	0	2019	21 Counties in Central PA		2	31884	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	007	0	1	01	01	H3962_007_0	5	1				07/09/2018	2019.01	07/09/2018 02:29:03 PM Eastern Daylight Time	08/02/2018 02:02:58 PM Eastern Daylight Time	08/02/2018 02:03:54 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Essential (HMO)	01	01		1			H3962	007	0	2019	21 Counties in Central PA		2	111519	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	018	0	1	01	01	H3962_018_0	4	1		1		07/09/2018	2019.01	07/09/2018 02:34:26 PM Eastern Daylight Time	08/02/2018 02:05:34 PM Eastern Daylight Time	08/02/2018 02:07:08 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Alliance Lung Care (HMO SNP)	01	01		1			H3962	018	0	2019	Lancaster County		2	94	2			1	4			00000000000100000000		www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	019	0	1	01	01	H3962_019_0	3	1		1		07/09/2018	2019.01	07/09/2018 02:37:50 PM Eastern Daylight Time	08/02/2018 02:08:40 PM Eastern Daylight Time	08/02/2018 02:09:38 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Alliance Heart and Diabetes Care (HMO SNP)	01	01		1			H3962	019	0	2019	Lancaster County		2	206	2			1	4			00000000000000000010		www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	020	0	1	01	01	H3962_020_0	3	1		1		07/09/2018	2019.01	07/09/2018 02:40:52 PM Eastern Daylight Time	08/02/2018 02:11:34 PM Eastern Daylight Time	08/02/2018 02:12:50 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Alliance Assisted Care (HMO SNP)	01	01		1			H3962	020	0	2019	6 Counties in Central PA		2	651	2			1	1	3				www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	801	0	1	01	01	H3962_801_0	1	1				06/02/2018	2019.01	06/02/2018 03:30:09 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney ERH with Rx (HMO)	01	01		1			H3962	801	0	2019	National		1	13978	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	802	0	1	01	01	H3962_802_0	1	1				06/02/2018	2019.01	06/02/2018 03:31:14 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney ERH without Rx (HMO)	01	01		1			H3962	802	0	2019	National		1	19623	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	803	0	1	01	01	H3962_803_0	1	1				06/02/2018	2019.01	06/02/2018 03:31:34 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney ERH Non-Calendar with Rx (HMO)	01	01		1			H3962	803	0	2019	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3979	001	0	1	01	01	H3979_001_0	8	1				07/09/2018	2019.01	07/09/2018 11:27:45 AM Central Daylight Time	08/06/2018 12:53:59 PM Central Daylight Time	08/01/2018 11:57:21 AM Central Daylight Time			08/07/2018 09:14:24 AM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.getblueok.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3979	001	0	2019	Oklahoma City Metro Area		2	53922	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3979	801	0	1	01	01	H3979_801_0	4	1				06/18/2018	2019.01	06/18/2018 01:58:01 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.getblueok.com/mapd	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	801	0	2019	State of Oklahoma		1	1	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3979	803	0	1	01	01	H3979_803_0	4	1				06/18/2018	2019.01	06/18/2018 01:58:32 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.getblueok.com/mapd	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	803	0	2019	State of Oklahoma		1	1	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H3979	805	0	1	01	01	H3979_805_0	4	1				06/18/2018	2019.01	06/18/2018 01:58:47 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.getblueok.com/mapd	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	805	0	2019	State of Oklahoma		1	1	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H4000	001	0	1	20	08	H4000_001_0	1	1				05/23/2018	2019.01	05/23/2018 11:10:38 AM Mountain Daylight Time		05/23/2018 12:16:18 PM Mountain Daylight Time			05/23/2018 12:18:08 PM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	001-Dual Eligible (PACE)	08	20		1			H4000	001	0	2019	001-Wyoming PACE		2		2			2						www.seniorscript.com	www.seniorscript.com										(307)773-8112		(307)773-8112		(307)773-8112		(307)773-8112										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965																
H4000	002	0	1	20	08	H4000_002_0	1	1				05/23/2018	2019.01	05/23/2018 11:11:04 AM Mountain Daylight Time		05/23/2018 12:16:39 PM Mountain Daylight Time			05/23/2018 12:18:08 PM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	002-Medicare Only (PACE)	08	20		1			H4000	002	0	2019	002-Wyoming PACE		2		2			2						www.seniorscript.com	www.seniorscript.com										(307)773-8112		(307)773-8112		(307)773-8112		(307)773-8112										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965																
H4003	009	0	1	01	01	H4003_009_0	7	1		1		08/06/2018	2019.01	08/06/2018 01:24:00 PM SA Western Standard Time	08/06/2018 01:08:15 PM SA Western Standard Time	08/06/2018 03:43:46 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Supremo (HMO SNP)	01	01		1			H4003	009	0	2019	Puerto Rico		2	94947	2			1	4			00000000000000000010		www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	7d;9a2;12;	
H4003	017	0	1	01	01	H4003_017_0	9	1	1	1		08/06/2018	2019.01	08/06/2018 01:43:33 PM SA Western Standard Time	08/06/2018 04:08:25 PM SA Western Standard Time	08/06/2018 03:52:24 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Diamante Platino (HMO SNP)	01	01		1			H4003	017	0	2019	Puerto Rico		2	540199	2		1	1	3		2		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	019	0	1	02	01	H4003_019_0	8	1				08/06/2018	2019.01	08/06/2018 01:25:51 PM SA Western Standard Time	08/06/2018 02:09:30 PM SA Western Standard Time	08/06/2018 03:55:06 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Unico (HMO-POS)	01	02		1			H4003	019	0	2019	Puerto Rico		2	36499	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	7d;9a2;12;	
H4003	034	0	1	02	01	H4003_034_0	8	1				08/06/2018	2019.01	08/06/2018 01:33:07 PM SA Western Standard Time	08/06/2018 04:24:17 PM SA Western Standard Time	08/06/2018 04:02:10 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Elite (HMO-POS)	01	02		1			H4003	034	0	2019	Puerto Rico		2	455906	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	7d;9a2;12;	
H4003	041	0	1	01	01	H4003_041_0	9	1	1	1		08/06/2018	2019.01	08/06/2018 01:44:36 PM SA Western Standard Time	08/06/2018 04:29:33 PM SA Western Standard Time	08/06/2018 04:05:48 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Completo Platino (HMO SNP)	01	01		1			H4003	041	0	2019	Puerto Rico		2	347986	2		1	1	3		2		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	044	0	1	02	01	H4003_044_0	8	1				08/06/2018	2019.01	08/06/2018 01:34:35 PM SA Western Standard Time	08/06/2018 04:33:56 PM SA Western Standard Time	08/06/2018 04:09:37 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Extra (HMO-POS)	01	02		1			H4003	044	0	2019	Puerto Rico		2	13036	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	7d;9a2;12;	
H4003	045	0	1	02	01	H4003_045_0	7	1				08/06/2018	2019.01	08/06/2018 01:38:49 PM SA Western Standard Time	08/06/2018 04:38:16 PM SA Western Standard Time	08/06/2018 04:12:58 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Cero (HMO-POS)	01	02		1			H4003	045	0	2019	Puerto Rico		2	184375	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	7d;9a2;12;	
H4003	047	0	1	01	01	H4003_047_0	8	1	1	1		07/18/2018	2019.01	07/18/2018 09:14:59 PM SA Western Standard Time	08/06/2018 04:41:45 PM SA Western Standard Time	08/06/2018 04:18:59 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Valor Platino (HMO SNP)	01	01		1			H4003	047	0	2019	Puerto Rico		2	30324	2		1	1	3		2		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	806	0	1	02	01	H4003_806_0	4	1				06/02/2018	2019.01	06/02/2018 09:50:54 PM SA Western Standard Time					06/04/2018 11:30:04 AM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Flex Group Calendar (HMO-POS)	01	02		1			H4003	806	0	2019	Puerto Rico		1	144000	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2				
H4003	807	0	1	02	01	H4003_807_0	4	1				06/02/2018	2019.01	06/02/2018 08:43:32 PM SA Western Standard Time					06/04/2018 11:30:04 AM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Flex Group Non Calendar (HMO-POS)	01	02		1			H4003	807	0	2019	Puerto Rico		1	951	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2				
H4003	820	0	1	01	01	H4003_820_0	4	1				06/02/2018	2019.01	06/02/2018 08:44:11 PM SA Western Standard Time					06/04/2018 11:30:04 AM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Relax Group Calendar (HMO)	01	01		1			H4003	820	0	2019	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1					2				
H4003	821	0	1	01	01	H4003_821_0	4	1				06/03/2018	2019.01	06/03/2018 10:44:44 AM SA Western Standard Time					06/04/2018 11:30:04 AM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmm-pr.com	MMM Relax Group Non Calendar (HMO)	01	01		1			H4003	821	0	2019	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1					2				
H4004	048	0	1	01	01	H4004_048_0	9	1	1	1		08/06/2018	2019.01	08/06/2018 01:51:25 PM SA Western Standard Time	08/06/2018 04:47:40 PM SA Western Standard Time	08/06/2018 04:23:39 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC Premier Platino (HMO SNP)	01	01		1			H4004	048	0	2019	PUERTO RICO		2		2		1	1	3		2		2	www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		2					2					2	2			
H4004	056	0	1	02	01	H4004_056_0	9	1				08/06/2018	2019.01	08/06/2018 01:41:24 PM SA Western Standard Time	08/06/2018 04:49:30 PM SA Western Standard Time	08/06/2018 04:25:43 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC Max (HMO-POS)	01	02		1			H4004	056	0	2019	PUERTO RICO		2		2			2						www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		2					2					2	1	01	7d;9a2;12;	
H4004	061	0	1	01	01	H4004_061_0	7	1	1	1		08/06/2018	2019.01	08/06/2018 01:46:00 PM SA Western Standard Time	08/06/2018 04:52:25 PM SA Western Standard Time	08/06/2018 04:29:29 PM SA Western Standard Time			08/07/2018 01:49:01 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmm-pr.com	MMM Relax Platino (HMO SNP)	01	01		1			H4004	061	0	2019	Puerto Rico		2	5000	2		1	1	3		2		2	www.pmcpr.org	www.mmm-pr.com	www.pmcpr.org	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	2			
H4004	817	0	1	02	01	H4004_817_0	5	1				06/19/2018	2019.01	06/19/2018 04:18:28 PM SA Western Standard Time					06/19/2018 04:31:52 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC Max Extra Group Non Calendar (HMO-POS)	01	02		1			H4004	817	0	2019	Puerto Rico		1	0	2			2						www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2				
H4004	818	0	1	02	01	H4004_818_0	5	1				06/19/2018	2019.01	06/19/2018 04:18:48 PM SA Western Standard Time					06/19/2018 04:31:52 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC Max Extra Group Calendar (HMO-POS)	01	02		1			H4004	818	0	2019	Puerto Rico		1	254948	2			2						www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2				
H4004	819	0	1	01	01	H4004_819_0	4	1				06/02/2018	2019.01	06/02/2018 08:45:37 PM SA Western Standard Time					06/04/2018 11:30:04 AM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC Max Group Non Calendar (HMO)	01	01		1			H4004	819	0	2019	Puerto Rico		1	0	2			2						www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1					2				
H4004	820	0	1	01	01	H4004_820_0	4	1				06/02/2018	2019.01	06/02/2018 08:51:53 PM SA Western Standard Time					06/04/2018 11:30:04 AM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC Max Group Calendar (HMO)	01	01		1			H4004	820	0	2019	Puerto Rico		1	0	2			2						www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		(866)516-7701		(866)516-7701		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;18a;	1	1a;1b;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	1					2				
H4005	001	0	1	04	01	H4005_001_0	7	1				07/26/2018	2019.01	07/26/2018 12:05:34 PM SA Western Standard Time	07/12/2018 03:43:18 PM SA Western Standard Time				07/26/2018 12:11:38 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	001	0	2019	Puerto Rico		2	11672	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2						1	11	7d;7f;8a1;8a2;8b1;8b2;8b3;	7f;
H4005	004	0	1	04	01	H4005_004_0	10	1				08/03/2018	2019.01	08/03/2018 09:13:37 AM SA Western Standard Time	08/03/2018 02:20:56 PM SA Western Standard Time	08/01/2018 09:31:03 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus (PPO)	01	04		1			H4005	004	0	2019	Puerto Rico		2	68538	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2						1	11	7d;7f;8a1;8a2;8b1;8b2;8b3;	7f;
H4005	801	0	1	04	01	H4005_801_0	6	1				06/04/2018	2019.01	06/04/2018 05:11:35 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	801	0	2019	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	802	0	1	04	01	H4005_802_0	6	1				06/04/2018	2019.01	06/04/2018 05:12:04 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus A (PPO)	01	04		1			H4005	802	0	2019	Puerto Rico		1	93515	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	804	0	1	04	01	H4005_804_0	6	1				06/04/2018	2019.01	06/04/2018 05:12:29 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus B (PPO)	01	04		1			H4005	804	0	2019	Puerto Rico		1	1812	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	807	0	1	04	01	H4005_807_0	6	1				06/04/2018	2019.01	06/04/2018 05:12:56 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus C (PPO)	01	04		1			H4005	807	0	2019	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	808	0	1	04	01	H4005_808_0	6	1				06/04/2018	2019.01	06/04/2018 05:13:17 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus D (PPO)	01	04		1			H4005	808	0	2019	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4007	012	0	1	01	01	H4007_012_0	5	1				07/02/2018	2019.01	07/02/2018 01:41:36 PM Eastern Daylight Time	07/18/2018 01:58:33 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:12:50 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4007-012 (HMO)	01	01		1			H4007	012	0	2019	Puerto Rico Island Wide		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	013	0	1	01	01	H4007_013_0	4	1				07/02/2018	2019.01	07/02/2018 01:41:58 PM Eastern Daylight Time	08/03/2018 03:25:03 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:12:50 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4007-013 (HMO)	01	01		1			H4007	013	0	2019	Puerto Rico Island Wide		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	016	0	1	01	01	H4007_016_0	3	1	1	1		05/29/2018	2019.01	05/29/2018 04:18:45 PM Eastern Daylight Time	07/18/2018 01:57:22 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:11:17 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-016 (HMO SNP)	01	01		1			H4007	016	0	2019	Puerto Rico Island Wide		2		2		1	1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	018	0	1	01	01	H4007_018_0	3	1	1	1		05/29/2018	2019.01	05/29/2018 03:29:38 PM Eastern Daylight Time	07/18/2018 01:57:58 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:12:50 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-018 (HMO SNP)	01	01		1			H4007	018	0	2019	Puerto Rico Island Wide		2		2		1	1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	019	0	1	01	01	H4007_019_0	3	1	1	1		05/29/2018	2019.01	05/29/2018 03:30:18 PM Eastern Daylight Time	07/18/2018 02:00:43 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:12:50 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-019 (HMO SNP)	01	01		1			H4007	019	0	2019	Puerto Rico Island Wide		2		2		1	1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	020	0	1	01	01	H4007_020_0	4	1				07/02/2018	2019.01	07/02/2018 01:42:11 PM Eastern Daylight Time	07/18/2018 02:01:13 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:12:50 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4007-020 (HMO)	01	01		1			H4007	020	0	2019	Puerto Rico Island Wide		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	801	0	1	01	01	H4007_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:36:26 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	801	0	2019	Puerto Rico - Island Wide		1	37846	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4007	802	0	1	01	01	H4007_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:36:57 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	802	0	2019	Puerto Rico - Island Wide		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4036	008	0	1	04	01	H4036_008_0	7	1				08/03/2018	2019.01	08/03/2018 10:56:21 AM Eastern Daylight Time	08/06/2018 12:32:19 AM Eastern Daylight Time	08/01/2018 08:12:05 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	008	0	2019	Select Counties in Wisconsin		2	28056	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940		(855)690-7802		(855)690-7802		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	009	0	1	04	01	H4036_009_0	7	1				08/03/2018	2019.01	08/03/2018 12:14:54 PM Eastern Daylight Time	08/06/2018 12:33:19 AM Eastern Daylight Time	08/01/2018 08:12:49 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	009	0	2019	Select Counties in Wisconsin		2	5724	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940		(855)690-7802		(855)690-7802		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	010	1	1	04	01	H4036_010_1	7	1				08/03/2018	2019.01	08/03/2018 12:23:13 PM Eastern Daylight Time	08/06/2018 12:34:19 AM Eastern Daylight Time	08/01/2018 08:13:34 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	010	1	2019	Select Counties in Ohio	Select Counties in Ohio	2	71244	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(800)797-5940		(800)797-5940		(855)690-7801		(855)690-7801		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	010	2	1	04	01	H4036_010_2	7	1				06/04/2018	2019.01	06/04/2018 09:51:50 AM Eastern Daylight Time	08/06/2018 12:35:20 AM Eastern Daylight Time	08/01/2018 08:14:18 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	010	2	2019	Select Counties in Ohio	Select Counties in Ohio	2	50400	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(800)797-5940		(800)797-5940		(855)690-7801		(855)690-7801		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	016	0	1	04	01	H4036_016_0	6	1				06/04/2018	2019.01	06/04/2018 09:52:00 AM Eastern Daylight Time	07/18/2018 04:58:06 PM Eastern Daylight Time				07/18/2018 07:35:38 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Core (PPO)	01	04		1			H4036	016	0	2019	Select Counties in Wisconsin		2	1884	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4036	017	0	1	04	01	H4036_017_0	7	1				06/04/2018	2019.01	06/04/2018 09:52:09 AM Eastern Daylight Time	08/06/2018 12:37:21 AM Eastern Daylight Time	08/01/2018 08:15:03 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Plus (PPO)	01	04		1			H4036	017	0	2019	Select Counties in Ohio		2	61416	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(800)797-5940		(800)797-5940		(855)690-7801		(855)690-7801		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	801	0	1	04	01	H4036_801_0	2	1				06/19/2018	2019.01	06/19/2018 01:00:07 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	801	0	2019	Wisconsin		1	32635	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	802	0	1	04	01	H4036_802_0	2	1				06/19/2018	2019.01	06/19/2018 01:00:15 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	802	0	2019	Wisconsin		1	3365	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)909-0464		(866)909-0464		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	803	0	1	04	01	H4036_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:00:23 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	803	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	805	0	1	04	01	H4036_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:00:33 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	805	0	2019	National (ASO)		1	77662	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)909-0433		(866)909-0433		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	806	0	2	04	01	H4036_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:01:13 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	806	0	2019	National (Part B Only)		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	807	0	1	04	01	H4036_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:01:24 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	807	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)909-0464		(866)909-0464		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	808	0	2	04	01	H4036_808_0	2	1				06/19/2018	2019.01	06/19/2018 01:01:35 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	808	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	809	0	2	04	01	H4036_809_0	2	1				06/19/2018	2019.01	06/19/2018 01:01:50 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	809	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)909-0464		(866)909-0464		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	810	0	2	04	01	H4036_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:01:58 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	810	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)909-0464		(866)909-0464		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	811	0	1	04	01	H4036_811_0	2	1				06/19/2018	2019.01	06/19/2018 01:02:05 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	811	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	812	0	1	04	01	H4036_812_0	2	1				06/19/2018	2019.01	06/19/2018 01:02:16 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	812	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)909-0464		(866)909-0464		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	813	0	1	04	01	H4036_813_0	2	1				06/19/2018	2019.01	06/19/2018 01:02:25 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	813	0	2019	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)909-0464		(866)909-0464		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4053	001	0	1	20	08	H4053_001_0	1	1				05/21/2018	2019.01	05/21/2018 02:23:06 PM Eastern Daylight Time		05/21/2018 09:39:30 AM Eastern Daylight Time			05/21/2018 02:25:11 PM Eastern Daylight Time	GREENVILLE HEALTH SYSTEM	GHS Senior Care	https://www.ghs.org/healthcareservices/seniorcare/	GHS Senior Care - Dual Eligible (PACE)	08	20		1			H4053	001	0	2019	Anderson, Greenville and Pickens counties		2		2			2						https://www.ghs.org/healthcareservices/upstate-pharmacy/	N/A	https://www.ghs.org/providers/ohmar-win/											(864)522-1950				(864)522-1950												(711)-				(711)-																
H4053	002	0	1	20	08	H4053_002_0	1	1				05/21/2018	2019.01	05/21/2018 02:23:43 PM Eastern Daylight Time		05/21/2018 09:39:38 AM Eastern Daylight Time			05/21/2018 02:25:11 PM Eastern Daylight Time	GREENVILLE HEALTH SYSTEM	GHS Senior Care	https://www.ghs.org/healthcareservices/seniorcare/	GHS Senior Care - Medicare Only (PACE)	08	20		1			H4053	002	0	2019	Anderson, Greenville and Pickens counties		2		2			2						https://www.ghs.org/healthcareservices/upstate-pharmacy/	N/A	https://www.ghs.org/providers/ohmar-win/											(864)522-1950				(864)522-1950												(711)-				(711)-																
H4074	001	0	1	20	08	H4074_001_0	2	1				05/31/2018	2019.01	05/31/2018 12:40:56 PM Central Daylight Time		05/31/2018 11:19:27 AM Central Daylight Time			05/31/2018 12:42:16 PM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	001	0	2019	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2						pharmastarpbm.com	www.mercylifeal.com	mercylifeal.com									(855)367-6562		(251)287-8420		(855)367-6562		(251)287-8420										(855)212-1552		(855)212-1552		(855)212-1552		(855)212-1552																
H4074	002	0	1	20	08	H4074_002_0	2	1				05/31/2018	2019.01	05/31/2018 12:41:08 PM Central Daylight Time		05/31/2018 11:19:12 AM Central Daylight Time			05/31/2018 12:42:16 PM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	002	0	2019	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2						pharmastarpbm.com	www.mercylifeal.com	mercylifeal.com									(855)367-6562		(251)287-8420		(855)367-6562		(251)287-8420										(855)212-1552		(855)212-1552		(855)212-1552		(855)212-1552																
H4089	001	0	1	01	01	H4089_001_0	4	1				08/02/2018	2019.01	08/02/2018 12:54:30 PM Central Daylight Time	08/03/2018 10:00:39 AM Central Daylight Time	07/31/2018 07:05:28 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF LOUISIANA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H4089	001	0	2019	New Orleans Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4089	002	0	1	01	01	H4089_002_0	4	1				07/10/2018	2019.01	07/10/2018 10:23:29 AM Central Daylight Time	08/03/2018 10:01:16 AM Central Daylight Time	07/31/2018 07:05:50 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF LOUISIANA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H4089	002	0	2019	New Orleans Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4091	001	0	1	04	01	H4091_001_0	3	1		1		05/30/2018	2019.01	05/30/2018 09:24:10 PM Eastern Daylight Time	08/07/2018 11:02:05 AM Eastern Daylight Time	08/07/2018 11:02:06 AM Eastern Daylight Time			08/07/2018 11:04:05 AM Eastern Daylight Time	SIMPRA ADVANTAGE, INC.	SIMPRA Advantage (PPO SNP)	www.simpra.com	Simpra Advantage (PPO SNP)	01	04		1			H4091	001	0	2019	Alabama statewide		2	34784	2			1	1	1				www.simpra.com	www.simpra.com	www.simpra.com	(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4091	002	0	1	04	01	H4091_002_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 09:21:20 PM Eastern Daylight Time	08/07/2018 11:02:06 AM Eastern Daylight Time	08/07/2018 11:02:06 AM Eastern Daylight Time			08/07/2018 11:04:05 AM Eastern Daylight Time	SIMPRA ADVANTAGE, INC.	SIMPRA Advantage (PPO SNP)	www.simpra.com	Simpra Advantage (PPO SNP)	01	04		1			H4091	002	0	2019	Alabama statewide		2	600	2			1	3		2		1	www.simpra.com	www.simpra.com	www.simpra.com	(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4093	001	0	1	01	01	H4093_001_0	5	1		1		08/06/2018	2019.01	08/06/2018 05:00:19 PM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time			08/07/2018 03:07:55 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Provider Partners Pennsylvania Advantage Plan	www.pphealthplanpa.com	Provider Partners Pennsylvania Advantage Plan (HMO SNP)	01	01		1			H4093	001	0	2019	PA East & West Borders		2	23667	2			1	1	1				www.pphealthplanpa.com	www.pphealthplanpa.com	www.pphealthplanpa.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H4094	001	0	1	01	01	H4094_001_0	6	1	2	1		08/02/2018	2019.01	08/02/2018 01:11:20 PM Central Daylight Time	08/03/2018 12:08:55 PM Central Daylight Time	07/31/2018 07:06:16 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	OPTIMUM CHOICE, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4094	001	0	2019	Montgomery County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)262-9919		(866)262-9919		(888)834-3721		(888)834-3721		(866)262-9919		(866)262-9919		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4105	001	0	1	20	08	H4105_001_0	1	1				05/23/2018	2019.01	05/23/2018 05:16:44 PM Eastern Daylight Time		05/23/2018 05:00:27 PM Eastern Daylight Time			05/23/2018 05:18:51 PM Eastern Daylight Time	PACE ORGANIZATION OF RHODE ISLAND	PACE Organization Of Rhode Island	www.pace-ri.org	PACE Organization of Rhode Island (PACE)	08	20		1			H4105	001	0	2019	PACE Organization of Rhode Island		2		2			2						www.pace-ri.org	www.pace-ri.org										(877)781-7223		(401)490-6566		(877)781-7223		(401)490-6566										(800)745-5555		(800)745-5555		(800)745-5555		(800)745-5555																
H4105	002	0	1	20	08	H4105_002_0	1	1				05/23/2018	2019.01	05/23/2018 05:17:16 PM Eastern Daylight Time		05/23/2018 05:00:28 PM Eastern Daylight Time			05/23/2018 05:18:51 PM Eastern Daylight Time	PACE ORGANIZATION OF RHODE ISLAND	PACE Organization Of Rhode Island	www.pace-ri.org	PACE Organization of Rhode Island (PACE)	08	20		1			H4105	002	0	2019	PACE Organization of Rhode Island		2		2			2						www.pace-ri.org	www.pace-ri.org										(877)781-7223		(401)490-6566		(877)781-7223		(401)490-6566										(800)745-5555		(800)745-5555		(800)745-5555		(800)745-5555																
H4118	001	0	1	20	08	H4118_001_0	1	1				05/21/2018	2019.01	05/21/2018 11:39:48 AM Eastern Daylight Time		05/21/2018 11:31:50 AM Eastern Daylight Time			05/21/2018 11:42:17 AM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Dual Eligible (PACE)	08	20		1			H4118	001	0	2019	Wash Co, Parts of Mon, Oak, Wayne & Livingston Co		2		2			2						http://www.hometownpharmacy.com/	http://huronvalleypace.org/										(855)483-7223		(734)572-5777		(855)483-7223		(734)572-5777										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H4118	002	0	1	20	08	H4118_002_0	1	1				05/21/2018	2019.01	05/21/2018 11:40:14 AM Eastern Daylight Time		05/21/2018 11:31:40 AM Eastern Daylight Time			05/21/2018 11:42:17 AM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Medicare Only (PACE)	08	20		1			H4118	002	0	2019	Wash Co, Parts of Mon, Oak, Wayne & Livingston Co		2		2			2						http://www.hometownpharmacy.com/	http://huronvalleypace.org/										(855)483-7223		(734)572-5777		(855)483-7223		(734)572-5777										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H4140	001	0	1	02	01	H4140_001_0	10	1				08/06/2018	2019.01	08/06/2018 01:29:58 PM Mountain Daylight Time	08/06/2018 01:03:34 PM Eastern Daylight Time	08/01/2018 01:19:53 PM Eastern Daylight Time			08/06/2018 06:28:24 PM Eastern Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrMax (HMO-POS)	01	02		1			H4140	001	0	2019	Miami-Dade County		2		2			2						www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4140	002	0	1	02	01	H4140_002_0	10	1	2	1		08/06/2018	2019.01	08/06/2018 01:31:40 PM Mountain Daylight Time	08/06/2018 01:04:45 PM Eastern Daylight Time	08/01/2018 01:20:40 PM Eastern Daylight Time			08/06/2018 06:28:24 PM Eastern Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrPlus (HMO-POS SNP)	01	02		1			H4140	002	0	2019	Miami-Dade County		2		2			1	3		1		2	www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4140	003	0	1	02	01	H4140_003_0	10	1		1		08/06/2018	2019.01	08/06/2018 01:30:15 PM Mountain Daylight Time	08/06/2018 01:06:05 PM Eastern Daylight Time	08/01/2018 01:22:19 PM Eastern Daylight Time			08/06/2018 06:28:24 PM Eastern Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrCare (HMO-POS SNP)	01	02		1			H4140	003	0	2019	Miami-Dade County		2		2			1	4			00001000000000000000		www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4140	004	0	1	02	01	H4140_004_0	10	1		1		08/06/2018	2019.01	08/06/2018 01:30:30 PM Mountain Daylight Time	08/06/2018 01:07:18 PM Eastern Daylight Time	08/01/2018 01:23:01 PM Eastern Daylight Time			08/06/2018 06:28:24 PM Eastern Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrExtra (HMO-POS SNP)	01	02		1			H4140	004	0	2019	Miami-Dade County		2		2			1	4			00000010000000000000		www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	003	0	1	01	01	H4141_003_0	5	1	2	1		08/01/2018	2019.01	08/01/2018 04:14:29 PM Eastern Daylight Time	08/03/2018 01:36:07 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4141-003 (HMO SNP)	01	01		1			H4141	003	0	2019	Greater Georgia Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	015	0	1	01	01	H4141_015_0	4	1				07/02/2018	2019.01	07/02/2018 01:20:15 PM Eastern Daylight Time	06/01/2018 03:02:42 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4141-015 (HMO)	01	01		1			H4141	015	0	2019	Atlanta Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	017	3	1	01	01	H4141_017_3	3	1				07/02/2018	2019.01	07/02/2018 01:21:51 PM Eastern Daylight Time	06/01/2018 03:18:55 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4141-017 (HMO)	01	01		1			H4141	017	3	2019	Atlanta	Atlanta Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	017	4	1	01	01	H4141_017_4	3	1				07/02/2018	2019.01	07/02/2018 01:22:17 PM Eastern Daylight Time	06/01/2018 03:12:15 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4141-017 (HMO)	01	01		1			H4141	017	4	2019	Atlanta	Atlanta	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	019	1	1	01	01	H4141_019_1	3	1				07/02/2018	2019.01	07/02/2018 01:23:06 PM Eastern Daylight Time	06/01/2018 03:23:56 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4141-019 (HMO)	01	01		1			H4141	019	1	2019	Select Counties in Georgia	Macon Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	019	2	1	01	01	H4141_019_2	3	1				07/06/2018	2019.01	07/06/2018 02:40:47 PM Eastern Daylight Time	06/01/2018 03:25:12 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4141-019 (HMO)	01	01		1			H4141	019	2	2019	Select Counties in Georgia	Coastal area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	801	0	1	01	01	H4141_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:38:01 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4141	801	0	2019	Select counties in Georgia		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4141	802	0	1	01	01	H4141_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:38:27 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4141	802	0	2019	Select counties in Georgia		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4142	001	0	1	20	08	H4142_001_0	1	1				05/24/2018	2019.01	05/24/2018 08:37:56 AM Central Daylight Time		05/23/2018 03:44:16 PM Central Daylight Time			05/24/2018 08:39:45 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	08	20		1			H4142	001	0	2019	Cherokee and surrounding counties		2		2			2						eldercare.cherokee.org	eldercare.cherokee.org										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554																
H4142	002	0	1	20	08	H4142_002_0	1	1				05/24/2018	2019.01	05/24/2018 08:38:23 AM Central Daylight Time		05/23/2018 03:46:23 PM Central Daylight Time			05/24/2018 08:39:45 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	08	20		1			H4142	002	0	2019	Cherokee and surrounding counties		2		2			2						eldercare.cherokee.org	eldercare.cherokee.org										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554																
H4152	004	0	1	01	01	H4152_004_0	9	1				07/18/2018	2019.01	07/18/2018 12:20:20 PM Eastern Daylight Time	07/18/2018 12:09:55 PM Eastern Daylight Time				07/18/2018 12:25:25 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Core (HMO)	01	01		1			H4152	004	0	2019	State of Rhode Island		2	12830	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7a;	
H4152	005	0	1	01	01	H4152_005_0	11	1				07/18/2018	2019.01	07/18/2018 12:20:32 PM Eastern Daylight Time	08/03/2018 10:19:51 AM Eastern Daylight Time	08/03/2018 10:20:14 AM Eastern Daylight Time			08/03/2018 11:22:56 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Plus (HMO)	01	01		1			H4152	005	0	2019	State of Rhode Island		2	43633	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H4152	007	0	1	02	01	H4152_007_0	11	1				07/18/2018	2019.01	07/18/2018 12:20:44 PM Eastern Daylight Time	08/03/2018 10:19:52 AM Eastern Daylight Time	08/03/2018 10:20:14 AM Eastern Daylight Time			08/03/2018 11:22:56 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Preferred (HMO-POS)	01	02		1			H4152	007	0	2019	State of Rhode Island		2	17882	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H4152	013	0	1	01	01	H4152_013_0	11	1				07/18/2018	2019.01	07/18/2018 12:20:57 PM Eastern Daylight Time	08/03/2018 10:19:53 AM Eastern Daylight Time	08/03/2018 10:20:16 AM Eastern Daylight Time			08/03/2018 11:22:56 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Standard with Drugs (HMO)	01	01		1			H4152	013	0	2019	State of Rhode Island		2	88407	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H4152	017	0	1	01	01	H4152_017_0	11	1				07/18/2018	2019.01	07/18/2018 12:21:10 PM Eastern Daylight Time	08/03/2018 10:19:54 AM Eastern Daylight Time	08/03/2018 10:20:17 AM Eastern Daylight Time			08/03/2018 11:22:56 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Advance (HMO)	01	01		1			H4152	017	0	2019	State of Rhode Island		2	126415	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4152	018	0	1	02	01	H4152_018_0	11	1				07/18/2018	2019.01	07/18/2018 12:21:31 PM Eastern Daylight Time	08/03/2018 10:19:55 AM Eastern Daylight Time	08/03/2018 10:20:18 AM Eastern Daylight Time			08/03/2018 11:22:56 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Extra (HMO-POS)	01	02		1			H4152	018	0	2019	State of Rhode Island		2	67005	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H4152	019	1	1	02	01	H4152_019_1	12	1				07/18/2018	2019.01	07/18/2018 12:21:49 PM Eastern Daylight Time	08/03/2018 10:19:55 AM Eastern Daylight Time	08/03/2018 10:20:19 AM Eastern Daylight Time			08/03/2018 11:22:56 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Value (HMO-POS)	01	02		1			H4152	019	1	2019	State of Rhode Island	Bristol, Kent, Providence and Washington County	2	232074	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H4152	019	2	1	02	01	H4152_019_2	12	1				07/18/2018	2019.01	07/18/2018 12:22:00 PM Eastern Daylight Time	08/03/2018 10:19:56 AM Eastern Daylight Time	08/03/2018 10:20:20 AM Eastern Daylight Time			08/03/2018 11:22:56 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Value (HMO-POS)	01	02		1			H4152	019	2	2019	State of Rhode Island	Newport County	2	17262	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H4152	815	0	1	02	01	H4152_815_0	6	1				05/25/2018	2019.01	05/25/2018 02:58:45 PM Eastern Daylight Time					06/04/2018 01:08:45 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Group Preferred (HMO-POS)	01	02		1			H4152	815	0	2019	RI, Bristol Cty MA, Partial New London Cty CT		1	32297	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e2;15;16b;17a;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e2;15;16b;17a;18a;	2		1				
H4152	817	0	1	01	01	H4152_817_0	6	1				05/25/2018	2019.01	05/25/2018 02:58:58 PM Eastern Daylight Time					06/04/2018 01:08:45 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Group Plus (HMO)	01	01		1			H4152	817	0	2019	RI, Bristol Cty MA, Partial New London Cty CT		1	6903	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e2;15;16b;17a;18a;	2		1					1				
H4172	001	0	1	01	01	H4172_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:04:00 AM Eastern Daylight Time	08/07/2018 02:52:05 PM Eastern Daylight Time	08/07/2018 02:52:05 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	NHC ADVANTAGE, LLC	NHC Advantage (HMO SNP)	www.nhcadvantage-mo.com	NHC Advantage (HMO SNP)	01	01		1			H4172	001	0	2019	MO Counties: CAM, GRE, JAK, JAS, SCH & STL		2	13569	2			1	1	3				www.nhcadvantage-mo.com	www.nhcadvantage-mo.com	www.nhcadvantage-mo.com	(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4172	002	0	1	01	01	H4172_002_0	3	1		1		06/03/2018	2019.01	06/03/2018 03:08:07 PM Eastern Daylight Time	07/19/2018 09:15:36 AM Eastern Daylight Time	07/19/2018 09:15:43 AM Eastern Daylight Time			07/19/2018 09:16:36 AM Eastern Daylight Time	NHC ADVANTAGE, LLC	NHC Advantage (HMO SNP)	www.NHCAdvantage-MO.com	NHC Advantage Gold (HMO SNP)	01	01		1			H4172	002	0	2019	Missouri (partial) Tennessee (partial)		2	3461	2			1	1	3				www.NHCAdvantage-MO.com	www.NHCAdvantage-MO.com	www.NHCAdvantage-MO.com	(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4198	001	0	1	01	01	H4198_001_0	6	1				07/11/2018	2019.01	07/11/2018 11:06:29 AM Eastern Daylight Time	06/20/2018 09:43:31 AM Eastern Daylight Time				07/24/2018 11:32:31 AM Eastern Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Advantage Medicare Plan (HMO)	www.ccokadvantage.com	Advantage Choice (HMO)	01	01		1			H4198	001	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		2		2			2						http://www.ccokadvantage.com	http://www.ccok.com/rxFormulary/?switch=7	www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202										(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353										2					2					2	2			
H4198	003	0	1	01	01	H4198_003_0	8	1				07/11/2018	2019.01	07/11/2018 11:07:00 AM Eastern Daylight Time	08/02/2018 01:32:55 PM Eastern Daylight Time	08/02/2018 10:29:02 AM Eastern Daylight Time			08/07/2018 02:11:25 PM Eastern Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Advantage Medicare Plan (HMO)	www.ccokadvantage.com	Advantage Premier (HMO)	01	01		1			H4198	003	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		2		2			2						http://www.ccokadvantage.com	http://www.ccok.com/rxFormulary/?switch=7	www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(800)333-3275		(918)594-5202		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H4198	005	0	1	01	01	H4198_005_0	9	1				07/11/2018	2019.01	07/11/2018 11:07:34 AM Eastern Daylight Time	08/02/2018 01:34:55 PM Eastern Daylight Time	08/02/2018 10:27:39 AM Eastern Daylight Time			08/07/2018 02:11:25 PM Eastern Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Advantage Medicare Plan (HMO)	www.ccokadvantage.com	Advantage Choice Plus (HMO)	01	01		1			H4198	005	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		2		2			2						http://www.ccokadvantage.com	http://www.ccok.com/rxFormulary/?switch=7	www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(800)333-3275		(918)594-5202		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H4198	802	0	1	01	01	H4198_802_0	4	1				06/03/2018	2019.01	06/03/2018 12:12:46 PM Eastern Daylight Time					06/04/2018 04:52:32 PM Eastern Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Advantage Medicare Plan (HMO)	www.ccokadvantage.com	Advantage Medicare EGHP+D (HMO)	01	01		1			H4198	802	0	2019	Counties CG, CK, MC, MU, NO, OS, TU, WG, WS		1	5400	2			2						http://www.ccokadvantage.com	http://www.ccok.com/rxFormulary/?switch=7	www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(877)293-8628		(918)594-5211		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;10a;11a;11b;12;14a;14d;14e2;14e6;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;12;14a;14d;14e2;16b;	1					1				
H4203	001	0	1	20	08	H4203_001_0	1	1				05/25/2018	2019.01	05/25/2018 10:20:42 AM Eastern Daylight Time		05/25/2018 10:32:37 AM Eastern Daylight Time			05/25/2018 10:35:13 AM Eastern Daylight Time	PALMETTO HEALTH ALLIANCE	Palmetto SeniorCare PACE	Palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	08	20		1			H4203	001	0	2019	Richland and  Lexington Counties		2		2			2						N/A	n/a										(803)931-8175		(803)931-8175		(803)931-8175		(803)931-8175										(803)434-7000		(803)434-7000		(803)434-7000		(803)434-7000																
H4203	002	0	1	20	08	H4203_002_0	1	1				05/23/2018	2019.01	05/23/2018 09:30:18 AM Eastern Daylight Time		05/25/2018 10:33:13 AM Eastern Daylight Time			05/25/2018 10:35:13 AM Eastern Daylight Time	PALMETTO HEALTH ALLIANCE	Palmetto SeniorCare PACE	Palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	08	20		1			H4203	002	0	2019	Richland and Lexington Counties		2		2			2						N/A	n/a										(803)931-8175		(803)931-8175		(803)931-8175		(803)931-8175	245									(803)434-7000		(803)434-7000		(803)434-7000		(803)434-7000																
H4213	016	1	1	09	04	H4213_016_1	4	1				07/18/2018	2019.01	07/18/2018 08:59:39 AM Central Daylight Time	06/04/2018 08:20:20 PM Central Daylight Time				07/18/2018 09:01:49 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	016	1	2019	State of Arkansas	Northern, Western and South Central AR counties	2	32784	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	016	3	1	09	04	H4213_016_3	4	1				07/18/2018	2019.01	07/18/2018 08:59:53 AM Central Daylight Time	07/17/2018 11:57:03 AM Central Daylight Time				07/18/2018 09:01:49 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	016	3	2019	State of Arkansas	Northwest, Western and Central AR counties	2	14040	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	016	4	1	09	04	H4213_016_4	4	1				07/18/2018	2019.01	07/18/2018 09:00:15 AM Central Daylight Time	06/04/2018 08:21:50 PM Central Daylight Time				07/18/2018 09:01:49 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	016	4	2019	State of Arkansas	East Central AR counties	2	10739	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	017	1	1	09	04	H4213_017_1	8	1				07/18/2018	2019.01	07/18/2018 08:51:54 AM Central Daylight Time	08/07/2018 07:22:22 AM Central Daylight Time	08/07/2018 07:22:23 AM Central Daylight Time			08/07/2018 07:29:05 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	017	1	2019	State of Arkansas	Northern, Western and South Central AR counties	2	44200	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	017	5	1	09	04	H4213_017_5	8	1				07/18/2018	2019.01	07/18/2018 08:50:43 AM Central Daylight Time	08/07/2018 07:22:24 AM Central Daylight Time	08/07/2018 07:22:25 AM Central Daylight Time			08/07/2018 07:29:05 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	017	5	2019	State of Arkansas	Northwest, Western and Central AR counties	2	28394	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	017	6	1	09	04	H4213_017_6	8	1				07/18/2018	2019.01	07/18/2018 08:51:21 AM Central Daylight Time	08/07/2018 07:22:26 AM Central Daylight Time	08/07/2018 07:22:27 AM Central Daylight Time			08/07/2018 07:29:05 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	017	6	2019	State of Arkansas	East Central AR counties	2	6421	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4227	001	0	1	01	01	H4227_001_0	6	1	2	1		06/04/2018	2019.01	06/04/2018 09:03:31 AM Central Daylight Time	08/03/2018 03:31:09 PM Central Daylight Time	08/03/2018 03:29:26 PM Central Daylight Time			08/07/2018 10:51:41 AM Central Daylight Time	VISTA HEALTH PLAN, INC.	VISTA Health Plan Inc.	www.keystonefirstvipchoice.com	Keystone First VIP Choice (HMO SNP)	01	01		1			H4227	001	0	2019	Eastern Pennsylvania		2		2			1	3		1		1	www.keystonefirstvipchoice.com	www.keystonefirstvipchoice.com	www.keystonefirstvipchoice.com	(800)450-1166		(800)450-1166		(855)241-3648		(855)241-3648		(800)450-1166		(800)450-1166		(855)241-3648		(855)241-3648		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4227	002	0	1	01	01	H4227_002_0	6	1	2	1		06/04/2018	2019.01	06/04/2018 09:02:56 AM Central Daylight Time	08/03/2018 03:32:09 PM Central Daylight Time	08/03/2018 03:30:09 PM Central Daylight Time			08/07/2018 10:51:41 AM Central Daylight Time	VISTA HEALTH PLAN, INC.	VISTA Health Plan Inc.	www.amerihealthcaritasvipcare.com	AmeriHealth Caritas VIP Care (HMO SNP)	01	01		1			H4227	002	0	2019	Eastern Pennsylvania		2		2			1	3		1		1	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.com	(866)533-5490		(866)533-5490		(855)241-3648		(855)241-3648		(866)533-5490		(866)533-5490		(855)241-3648		(855)241-3648		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4235	001	0	1	20	08	H4235_001_0	1	1				05/24/2018	2019.01	05/24/2018 01:02:55 PM Eastern Daylight Time		05/24/2018 12:55:50 PM Eastern Daylight Time			05/24/2018 01:10:35 PM Eastern Daylight Time	SENIOR TOTAL LIFE CARE, INC.	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Dual (PACE)	08	20		1			H4235	001	0	2019	Gaston County and Parts of Cleveland and Lincoln		2		2			2						www.seniortlc.org	www.seniorTLC.org	www.seniortlc.org									(855)327-7852		(704)874-0600		(855)327-7852		(704)874-0600										(704)874-3307		(704)874-3307		(704)874-3307		(704)874-3307																
H4235	002	0	1	20	08	H4235_002_0	1	1				05/24/2018	2019.01	05/24/2018 01:03:15 PM Eastern Daylight Time		05/24/2018 12:55:44 PM Eastern Daylight Time			05/24/2018 01:10:35 PM Eastern Daylight Time	SENIOR TOTAL LIFE CARE, INC.	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Medicare (PACE)	08	20		1			H4235	002	0	2019	Gaston, Lincoln and Cleveland Counties in NC		2		2			2						www.seniortlc.org	www.seniorTLC.org	www.seniortlc.org									(855)327-7852		(704)874-0600		(855)327-7852		(704)874-0600										(704)874-3307		(704)874-3307		(704)874-3307		(704)874-3307																
H4236	001	0	1	01	01	H4236_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:46:40 AM Eastern Daylight Time	08/07/2018 02:52:05 PM Eastern Daylight Time	08/07/2018 02:52:05 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN PA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan I-SNP (HMO SNP)	01	01		1			H4236	001	0	2019	Pennsylvania (partial)		2	1517	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4236	002	0	1	01	01	H4236_002_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:47:07 AM Eastern Daylight Time	08/07/2018 02:52:06 PM Eastern Daylight Time	08/07/2018 02:52:06 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN PA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan C-SNP (HMO SNP)	01	01		1			H4236	002	0	2019	Pennsylvania (partial)		2	1337	2			1	4			00000100000000000000		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4236	003	0	1	01	01	H4236_003_0	4	1				08/03/2018	2019.01	08/03/2018 09:47:36 AM Eastern Daylight Time	08/07/2018 02:52:06 PM Eastern Daylight Time	08/07/2018 02:52:06 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN PA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO)	01	01		1			H4236	003	0	2019	Pennsylvania (partial)		2	713	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4236	004	0	1	01	01	H4236_004_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:48:48 AM Eastern Daylight Time	08/07/2018 02:52:07 PM Eastern Daylight Time	08/07/2018 02:52:07 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN PA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan Gold (HMO SNP)	01	01		1			H4236	004	0	2019	Pennsylvania (partial)		2	892	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4279	001	0	1	01	01	H4279_001_0	7	1	2	1		07/24/2018	2019.01	07/24/2018 01:43:32 PM Eastern Daylight Time	08/02/2018 12:41:36 PM Eastern Daylight Time	08/01/2018 11:01:35 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC FOR YOU, INC	UPMC for You	www.upmchealthplan.com/snp	UPMC for Life Dual (HMO SNP)	01	01		1			H4279	001	0	2019	Pennsylvania		2	396561	2			1	3		1		1	www.upmchealthplan.com/medicare/documents-and-forms	www.upmchealthplan.com/medicare/documents-and-forms	http://www.upmchealthplan.com/snp	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		2					2					2	2			
H4305	001	0	1	20	08	H4305_001_0	1	1				05/23/2018	2019.01	05/23/2018 12:23:14 PM Central Daylight Time		05/21/2018 10:13:36 AM Central Daylight Time			05/23/2018 01:00:22 PM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	www.stbernards.info/	Total Life Healthcare Dual (PACE)	08	20		1			H4305	001	0	2019	Counties: Craighead Cross Greene Law MS Poin Rand		2		2			2						n/a	n/a										(855)207-7500		(870)207-7500		(855)207-7500		(870)207-7500										(000)000-0000		(870)207-0527		(000)000-0000		(870)207-0527																
H4305	002	0	1	20	08	H4305_002_0	1	1				05/23/2018	2019.01	05/23/2018 12:23:33 PM Central Daylight Time		05/21/2018 10:13:37 AM Central Daylight Time			05/23/2018 01:00:22 PM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	www.stbernards.info/	Total Life Healthcare Medicare only (PACE)	08	20		1			H4305	002	0	2019	Counties:Craighead Cross Greene Law MS Poin Rand		2		2			2						n/a	n/a										(855)207-7500		(870)207-7500		(855)207-7500		(870)207-7500										(000)000-0000		(870)207-0527		(000)000-0000		(870)207-0527																
H4326	001	0	1	20	08	H4326_001_0	1	1				05/23/2018	2019.01	05/23/2018 04:04:29 PM Eastern Daylight Time		05/22/2018 03:16:33 PM Eastern Daylight Time			05/23/2018 04:06:53 PM Eastern Daylight Time	PACE @ HOME, INC.	PACE@Home	www.pace-at-home.org	PACE at Home - dual (PACE)	08	20		1			H4326	001	0	2019	Catawba Co. and Surrounding Select Zip Codes		2		2			2						www.holladaycare.com	www.pharmastarpbm.com										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980																
H4326	002	0	1	20	08	H4326_002_0	1	1				05/23/2018	2019.01	05/23/2018 04:05:01 PM Eastern Daylight Time		05/22/2018 03:16:34 PM Eastern Daylight Time			05/23/2018 04:06:53 PM Eastern Daylight Time	PACE @ HOME, INC.	PACE@Home	www.pace-at-home.org	PACE at Home - medicare only (PACE)	08	20		1			H4326	002	0	2019	Catawba Co. and Surrounding Select Zip Codes		2		2			2						www.holladaycare.com	www.pharmastarpbm.com										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980																
H4346	001	0	1	01	01	H4346_001_0	7	1				07/24/2018	2019.01	07/24/2018 02:01:41 PM Pacific Daylight Time	08/01/2018 03:59:25 PM Pacific Daylight Time	07/31/2018 03:21:52 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Value Plus (HMO)	01	01		1			H4346	001	0	2019	Clark County		2	40074	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	005	0	1	01	01	H4346_005_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:22:15 PM Pacific Daylight Time	08/01/2018 04:04:39 PM Pacific Daylight Time	07/31/2018 03:22:13 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Breathe (HMO SNP)	01	01		1			H4346	005	0	2019	Clark County		2	7763	2			1	4			00000000000100000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	006	0	1	01	01	H4346_006_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:21:45 PM Pacific Daylight Time	08/01/2018 04:03:18 PM Pacific Daylight Time	07/31/2018 03:22:34 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Diabetes (HMO SNP)	01	01		1			H4346	006	0	2019	Clark County		2	22106	2			1	4			00000010000000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	008	0	1	01	01	H4346_008_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:22:51 PM Pacific Daylight Time	08/01/2018 04:06:01 PM Pacific Daylight Time	07/31/2018 03:22:55 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Heart (HMO SNP)	01	01		1			H4346	008	0	2019	Clark County		2	5974	2			1	4			00000000000000000010		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	009	0	1	01	01	H4346_009_0	7	1				08/01/2018	2019.01	08/01/2018 02:21:02 PM Pacific Daylight Time	08/01/2018 04:00:44 PM Pacific Daylight Time	07/31/2018 03:23:17 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem StartSmart Plus (HMO)	01	01		1			H4346	009	0	2019	Clark County		2	14474	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	010	0	1	01	01	H4346_010_0	7	1		1		08/01/2018	2019.01	08/01/2018 02:23:29 PM Pacific Daylight Time	08/01/2018 04:02:00 PM Pacific Daylight Time	07/31/2018 03:23:38 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Care On Site (HMO SNP)	01	01		1			H4346	010	0	2019	Clark County		2	11399	2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	011	0	1	01	01	H4346_011_0	8	1				08/01/2018	2019.01	08/01/2018 02:34:09 PM Pacific Daylight Time	08/01/2018 03:47:26 PM Pacific Daylight Time	07/31/2018 03:23:59 PM Pacific Daylight Time			08/02/2018 02:47:29 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Connect Plus (HMO)	01	01		1			H4346	011	0	2019	Clark County		2	9006	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	012	0	1	01	01	H4346_012_0	10	1				08/03/2018	2019.01	08/03/2018 04:26:30 PM Pacific Daylight Time	08/05/2018 09:38:22 PM Pacific Daylight Time	08/01/2018 05:15:48 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H4346	012	0	2019	Denver Metro Area		2	23848	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	013	0	1	01	01	H4346_013_0	11	1				08/03/2018	2019.01	08/03/2018 04:27:04 PM Pacific Daylight Time	08/05/2018 09:39:22 PM Pacific Daylight Time	08/01/2018 05:16:33 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H4346	013	0	2019	El Paso, Larimer, Pueblo and Weld Counties		2	14182	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	014	0	1	01	01	H4346_014_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 04:28:08 PM Pacific Daylight Time	08/05/2018 09:40:23 PM Pacific Daylight Time	08/01/2018 04:11:20 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H4346	014	0	2019	Greater Denver Area		2	11097	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)664-7175		(844)664-7175		(800)797-1746		(800)797-1746		(844)664-7175		(844)664-7175		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	017	0	1	01	01	H4346_017_0	11	1				08/03/2018	2019.01	08/03/2018 04:31:08 PM Pacific Daylight Time	08/05/2018 09:41:22 PM Pacific Daylight Time	08/01/2018 05:17:17 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Mediblue Plus (HMO)	01	01		1			H4346	017	0	2019	Clark County		2	5425	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	018	0	1	01	01	H4346_018_0	9	1				08/03/2018	2019.01	08/03/2018 04:32:09 PM Pacific Daylight Time	08/05/2018 09:42:22 PM Pacific Daylight Time	08/01/2018 04:13:07 PM Pacific Daylight Time			08/06/2018 04:40:56 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H4346	018	0	2019	Clark County		2	4684	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	801	0	1	01	01	H4346_801_0	1	1				04/30/2018	2019.01	04/30/2018 05:00:14 PM Pacific Daylight Time					05/31/2018 06:30:33 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	caremore.com	Anthem EGWP (HMO)	01	01		1			H4346	801	0	2019	Nevada		1	65	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4346	802	0	1	01	01	H4346_802_0	1	1				04/30/2018	2019.01	04/30/2018 05:06:00 PM Pacific Daylight Time					05/31/2018 06:30:33 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	caremore.com	Anthem EGWP MAPD (HMO)	01	01		1			H4346	802	0	2019	Nevada		1	65	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	804	0	1	01	01	H4346_804_0	1	1				04/30/2018	2019.01	04/30/2018 05:08:16 PM Pacific Daylight Time					05/31/2018 06:30:33 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	caremore.com	Anthem EGWP MAPD (HMO)	01	01		1			H4346	804	0	2019	Nevada		1	40	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	805	0	1	01	01	H4346_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:21:41 PM Pacific Daylight Time					06/19/2018 09:04:27 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		1			H4346	805	0	2019	Colorado - Select Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	806	0	2	01	01	H4346_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:21:46 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		2	1		H4346	806	0	2019	Colorado - Select Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	809	0	1	01	01	H4346_809_0	2	1				06/19/2018	2019.01	06/19/2018 01:21:50 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		1			H4346	809	0	2019	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	810	0	2	01	01	H4346_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:22:01 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		2	1		H4346	810	0	2019	Select Coloardo Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	811	0	1	01	01	H4346_811_0	2	1				06/19/2018	2019.01	06/19/2018 01:22:27 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		1			H4346	811	0	2019	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	812	0	1	01	01	H4346_812_0	2	1				06/19/2018	2019.01	06/19/2018 01:22:36 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		1			H4346	812	0	2019	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	813	0	2	01	01	H4346_813_0	2	1				06/19/2018	2019.01	06/19/2018 01:22:56 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		2	1		H4346	813	0	2019	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	821	0	2	01	01	H4346_821_0	2	1				06/19/2018	2019.01	06/19/2018 01:23:10 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	01	01		2	1		H4346	821	0	2019	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4388	001	0		07	02	H4388_001_0	2	2				05/31/2018	2019.01	05/31/2018 03:02:10 PM Central Daylight Time			06/02/2018 06:24:36 AM Central Daylight Time		06/02/2018 06:34:31 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Secure Saver (MSA)	02	07	2				H4388	001	0	2019	Wisconsin statewide		2		2			2						www.securityhealth.org/msapharmacies	www.securityhealth.org/securesaver	www.securityhealth.org/securesaver	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897										(711)-		(711)-		(711)-		(711)-																								
H4393	001	0	1	20	08	H4393_001_0	1	1				06/04/2018	2019.01	06/04/2018 09:59:07 AM Eastern Daylight Time		06/04/2018 06:08:11 AM Eastern Daylight Time			06/04/2018 10:09:24 AM Eastern Daylight Time	CATHOLIC MANAGED LONG TERM CARE, INC.	ArchCare Senior Life	www.ArchCareSeniorLife.org	ArchCare Senior Life - Dual (PACE)	08	20		1			H4393	001	0	2019	New York, Bronx, Richmond and Westchester counties		2		2			2						www.archcare.org	www.ArchCareSeniorLife.org										(866)263-9083		(866)263-9083		(866)263-9083		(866)263-9083										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
H4393	002	0	1	20	08	H4393_002_0	1	1				06/04/2018	2019.01	06/04/2018 10:01:01 AM Eastern Daylight Time		06/04/2018 06:08:07 AM Eastern Daylight Time			06/04/2018 10:09:24 AM Eastern Daylight Time	CATHOLIC MANAGED LONG TERM CARE, INC.	ArchCare Senior Life	www.ArchCareSeniorLife.org	ArchCare Senior Life - Medicare only (PACE)	08	20		1			H4393	002	0	2019	New York, Bronx, Richmond and Westchester counties		2		2			2						www.archcare.org	www.ArchCareSeniorLife.org										(866)263-9083		(866)263-9083		(866)263-9083		(866)263-9083										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
H4402	001	0	1	20	08	H4402_001_0	1	1				05/30/2018	2019.01	05/30/2018 03:20:39 PM Central Daylight Time		05/30/2018 02:12:56 PM Central Daylight Time			05/30/2018 03:22:13 PM Central Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianpacetn.net	Alexian Brothers Community Services (PACE)	08	20		1			H4402	001	0	2019	Hamilton County Area		2		2			2						None	None										(800)441-8883		(423)698-0802		(800)441-8883		(423)698-0802										(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298																
H4402	002	0	1	20	08	H4402_002_0	1	1				05/30/2018	2019.01	05/30/2018 03:21:09 PM Central Daylight Time		05/30/2018 02:12:58 PM Central Daylight Time			05/30/2018 03:22:13 PM Central Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianpacetn.net	Alexian Brothers Community Services (PACE)	08	20		1			H4402	002	0	2019	Hamilton County Area		2		2			2						None	None										(800)441-8883		(423)698-0802		(800)441-8883		(423)698-0802										(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298																
H4407	004	0	1	01	01	H4407_004_0	6	1	2	1		08/01/2018	2019.01	08/01/2018 05:07:43 PM Central Daylight Time	08/03/2018 09:04:08 AM Central Daylight Time	07/31/2018 09:00:49 PM Central Daylight Time			08/06/2018 11:41:49 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4407	004	0	2019	Select Mississippi Counties		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	011	0	1	01	01	H4407_011_0	3	1				07/20/2018	2019.01	07/20/2018 03:30:54 PM Central Daylight Time	07/16/2018 10:20:29 AM Central Daylight Time				07/21/2018 09:23:05 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4407	011	0	2019	Select Mississippi Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4407	026	0	1	01	01	H4407_026_0	4	1				08/01/2018	2019.01	08/01/2018 05:08:00 PM Central Daylight Time	08/03/2018 09:04:52 AM Central Daylight Time	07/31/2018 09:01:02 PM Central Daylight Time			08/06/2018 11:41:49 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4407	026	0	2019	Southern Mississippi		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	027	0	1	01	01	H4407_027_0	4	1				08/01/2018	2019.01	08/01/2018 05:08:18 PM Central Daylight Time	08/03/2018 09:05:14 AM Central Daylight Time	07/31/2018 09:01:15 PM Central Daylight Time			08/06/2018 11:41:49 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus Direct (HMO)	01	01		1			H4407	027	0	2019	Southern Mississippi		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	004	0	1	01	01	H4461_004_0	4	1				07/18/2018	2019.01	07/18/2018 05:04:22 PM Eastern Daylight Time	06/01/2018 01:24:44 PM Eastern Daylight Time				07/19/2018 04:55:58 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-004 (HMO)	01	01		1			H4461	004	0	2019	East Tennessee		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4461	022	0	1	01	01	H4461_022_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 02:28:21 PM Eastern Daylight Time	08/03/2018 12:18:41 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4461-022 (HMO SNP)	01	01		1			H4461	022	0	2019	Greater Tennessee		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	025	0	1	01	01	H4461_025_0	3	1				07/02/2018	2019.01	07/02/2018 02:47:50 PM Eastern Daylight Time	06/01/2018 01:26:38 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-025 (HMO)	01	01		1			H4461	025	0	2019	Memphis Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	029	0	1	01	01	H4461_029_0	3	1				07/02/2018	2019.01	07/02/2018 02:48:16 PM Eastern Daylight Time	06/01/2018 01:27:34 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-029 (HMO)	01	01		1			H4461	029	0	2019	Nashville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	030	1	1	01	01	H4461_030_1	4	1				07/02/2018	2019.01	07/02/2018 02:48:26 PM Eastern Daylight Time	06/01/2018 01:28:01 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	1	2019	East Tennessee	East Tennessee	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	030	2	1	01	01	H4461_030_2	3	1				07/02/2018	2019.01	07/02/2018 02:48:51 PM Eastern Daylight Time	06/01/2018 01:28:28 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	2	2019	East Tennessee	East Tennessee	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	030	3	1	01	01	H4461_030_3	3	1				07/02/2018	2019.01	07/02/2018 02:49:02 PM Eastern Daylight Time	06/01/2018 01:28:53 PM Eastern Daylight Time	08/03/2018 09:21:05 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	3	2019	East Tennessee	East Tennessee	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	031	1	1	01	01	H4461_031_1	3	1				07/03/2018	2019.01	07/03/2018 09:24:56 AM Eastern Daylight Time	06/01/2018 01:29:21 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	1	2019	East Tennessee	East Tennessee	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	031	2	1	01	01	H4461_031_2	4	1				07/03/2018	2019.01	07/03/2018 09:25:07 AM Eastern Daylight Time	07/17/2018 05:54:52 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	2	2019	East Tennessee	East Tennessee	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	031	3	1	01	01	H4461_031_3	3	1				07/03/2018	2019.01	07/03/2018 09:25:18 AM Eastern Daylight Time	06/01/2018 01:30:13 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	3	2019	East Tennessee	East Tennessee	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	034	0	1	01	01	H4461_034_0	3	1				07/03/2018	2019.01	07/03/2018 09:25:29 AM Eastern Daylight Time	06/01/2018 01:31:07 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-034 (HMO)	01	01		1			H4461	034	0	2019	East Tennessee		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	035	0	1	01	01	H4461_035_0	3	1				07/02/2018	2019.01	07/02/2018 03:05:37 PM Eastern Daylight Time	06/01/2018 01:38:12 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-035 (HMO)	01	01		1			H4461	035	0	2019	East Tennessee		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	036	0	1	01	01	H4461_036_0	3	1				07/02/2018	2019.01	07/02/2018 03:05:57 PM Eastern Daylight Time	06/01/2018 01:38:38 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-036 (HMO)	01	01		1			H4461	036	0	2019	East Tennessee		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	806	0	1	01	01	H4461_806_0	1	1				05/31/2018	2019.01	05/31/2018 12:39:32 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	806	0	2019	Select counties in East Tennessee area		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4461	807	0	1	01	01	H4461_807_0	1	1				05/31/2018	2019.01	05/31/2018 12:41:45 PM Eastern Daylight Time					05/31/2018 01:38:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	807	0	2019	Select counties in East Tennessee area		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4490	001	0	1	01	01	H4490_001_0	3	1		1		08/07/2018	2019.01	08/07/2018 10:32:04 AM Eastern Daylight Time	08/07/2018 02:52:07 PM Eastern Daylight Time	08/07/2018 02:52:07 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	MISSOURI MEDICARE SELECT, LLC	Missouri Medicare Select (HMO SNP)	www.missourimedicareselect.com	Missouri Medicare Select (HMO SNP)	01	01		1			H4490	001	0	2019	MO Counties: CAS, JAK, LAF, SCH & STL		2	1200	2			1	1	1				www.missourimedicareselect.com	www.missourimedicareselect.com	www.missourimedicareselect.com	(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4497	001	1	1	04	01	H4497_001_1	26	1				07/12/2018	2019.01	07/12/2018 12:12:46 PM Eastern Daylight Time	08/06/2018 12:39:07 PM Eastern Daylight Time	08/06/2018 12:38:55 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	1	2019	Ohio Regions	Region 1	2	29999	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	001	2	1	04	01	H4497_001_2	8	1				07/12/2018	2019.01	07/12/2018 08:37:14 AM Eastern Daylight Time	08/06/2018 12:39:08 PM Eastern Daylight Time	08/06/2018 12:38:56 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	2	2019	Ohio Regions	Region 2	2	5647	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	1	1	04	01	H4497_002_1	8	1				07/12/2018	2019.01	07/12/2018 08:38:04 AM Eastern Daylight Time	08/06/2018 12:39:09 PM Eastern Daylight Time	08/06/2018 12:38:57 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	1	2019	Ohio Regions	Region 1	2	26208	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	2	1	04	01	H4497_002_2	8	1				07/12/2018	2019.01	07/12/2018 08:38:24 AM Eastern Daylight Time	08/06/2018 12:39:10 PM Eastern Daylight Time	08/06/2018 12:38:58 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	2	2019	Ohio Regions	Region 2	2	4895	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	1	1	04	01	H4497_003_1	7	1				06/04/2018	2019.01	06/04/2018 10:39:36 AM Eastern Daylight Time	08/06/2018 12:39:11 PM Eastern Daylight Time	08/06/2018 12:38:59 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	1	2019	Ohio Regions	Region 1	2	32794	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	2	1	04	01	H4497_003_2	7	1				06/04/2018	2019.01	06/04/2018 10:40:30 AM Eastern Daylight Time	08/06/2018 12:39:12 PM Eastern Daylight Time	08/06/2018 12:39:05 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	2	2019	Ohio Regions	Region 2	2	4575	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	801	0	1	04	01	H4497_801_0	2	1				05/25/2018	2019.01	05/25/2018 12:51:40 PM Eastern Daylight Time					06/02/2018 09:08:43 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (Calendar Year) (PPO)	01	04		1			H4497	801	0	2019	Ohio Regions		1	5900	2			2						medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1									
H4497	802	0	1	04	01	H4497_802_0	2	1				05/25/2018	2019.01	05/25/2018 12:51:56 PM Eastern Daylight Time					06/02/2018 09:08:43 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (Non-Calendar Year) (PPO)	01	04		1			H4497	802	0	2019	Ohio Regions		1	50	2			2						medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1									
H4497	803	0	1	04	01	H4497_803_0	2	1				05/25/2018	2019.01	05/25/2018 12:52:07 PM Eastern Daylight Time					06/02/2018 09:08:43 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (MA-Only) (PPO)	01	04		1			H4497	803	0	2019	Ohio Regions		1	50	2			2						medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1									
H4506	003	0	1	01	01	H4506_003_0	7	1				08/03/2018	2019.01	08/03/2018 12:06:59 PM Eastern Daylight Time	08/06/2018 05:28:10 PM Eastern Daylight Time	08/01/2018 02:33:59 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	01	01		1			H4506	003	0	2019	Houston/Beaumont Area		2	763112	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	010	0	1	01	01	H4506_010_0	6	1				07/13/2018	2019.01	07/13/2018 09:42:05 AM Eastern Daylight Time	06/02/2018 02:51:15 AM Eastern Daylight Time				07/16/2018 05:05:02 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare TexanPlus Value (HMO)	01	01		1			H4506	010	0	2019	Houston/Beaumont Area		2	18963	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4506	029	0	1	02	01	H4506_029_0	8	1				08/03/2018	2019.01	08/03/2018 12:07:36 PM Eastern Daylight Time	08/06/2018 05:29:39 PM Eastern Daylight Time	08/01/2018 02:34:20 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare TexanPlus Choice (HMO-POS)	01	02		1			H4506	029	0	2019	Houston/Beaumont Area		2	13932	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	801	0	1	01	01	H4506_801_0	3	1				05/29/2018	2019.01	05/29/2018 10:51:57 PM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	H4506 - Retiree - MA-PD non-CY (HMO)	01	01		1			H4506	801	0	2019	TexanPlus-Employer Group (MAPD nonCY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4506	806	0	1	01	01	H4506_806_0	3	1				06/01/2018	2019.01	06/01/2018 11:53:45 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	H4506 - Retiree - MA-PD CY (HMO)	01	01		1			H4506	806	0	2019	TexanPlus-Employer Group (MAPD CY)		1	8474	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4506	808	0	1	01	01	H4506_808_0	3	1				05/30/2018	2019.01	05/30/2018 07:40:44 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	H4506 - Retiree MA (HMO)	01	01		1			H4506	808	0	2019	TexanValue-Employer Group (MA Only)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	009	0	1	01	01	H4513_009_0	2	1				05/27/2018	2019.01	05/27/2018 10:43:20 AM Central Daylight Time	07/16/2018 02:08:34 PM Central Daylight Time				07/19/2018 11:15:35 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4513	009	0	2019	Texas HealthSpring Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	010	0	1	01	01	H4513_010_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 01:43:46 PM Central Daylight Time	08/03/2018 11:09:06 AM Central Daylight Time	07/31/2018 09:01:30 PM Central Daylight Time			08/06/2018 11:07:44 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4513	010	0	2019	Texas HealthSpring Counties		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	025	0	1	01	01	H4513_025_0	3	1				08/02/2018	2019.01	08/02/2018 11:33:12 AM Central Daylight Time	08/03/2018 11:09:29 AM Central Daylight Time	07/31/2018 09:01:43 PM Central Daylight Time			08/06/2018 11:07:44 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	025	0	2019	Texas HealthSpring Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	026	0	1	01	01	H4513_026_0	3	1				08/02/2018	2019.01	08/02/2018 11:33:34 AM Central Daylight Time	08/03/2018 11:09:53 AM Central Daylight Time	07/31/2018 09:01:57 PM Central Daylight Time			08/06/2018 11:07:44 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	026	0	2019	Texas HealthSpring Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	027	0	1	01	01	H4513_027_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 11:34:04 AM Central Daylight Time	08/03/2018 11:10:16 AM Central Daylight Time	07/31/2018 09:02:11 PM Central Daylight Time			08/06/2018 11:07:44 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4513	027	0	2019	North Texas		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	028	0	1	01	01	H4513_028_0	3	1				08/02/2018	2019.01	08/02/2018 11:34:20 AM Central Daylight Time	08/03/2018 11:10:41 AM Central Daylight Time	07/31/2018 09:02:25 PM Central Daylight Time			08/06/2018 11:07:44 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	028	0	2019	Select Texas Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	029	0	1	01	01	H4513_029_0	3	1	2	1		05/25/2018	2019.01	05/25/2018 12:35:29 PM Central Daylight Time	08/03/2018 11:11:05 AM Central Daylight Time	07/31/2018 08:33:33 PM Central Daylight Time			08/06/2018 11:07:44 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4513	029	0	2019	Select Texas Counties		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	030	0	1	01	01	H4513_030_0	4	1				08/02/2018	2019.01	08/02/2018 04:17:01 PM Central Daylight Time	08/03/2018 11:42:02 AM Central Daylight Time	07/31/2018 08:33:46 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred NGA (HMO)	01	01		1			H4513	030	0	2019	Northwest Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	033	0	1	01	01	H4513_033_0	3	1				07/20/2018	2019.01	07/20/2018 03:32:34 PM Central Daylight Time	07/16/2018 02:12:16 PM Central Daylight Time				07/22/2018 09:38:24 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4513	033	0	2019	Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	034	0	1	01	01	H4513_034_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 03:32:48 PM Central Daylight Time	08/03/2018 11:42:48 AM Central Daylight Time	07/31/2018 08:34:27 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4513	034	0	2019	Middle and West Tennessee		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	035	0	1	01	01	H4513_035_0	4	1				07/20/2018	2019.01	07/20/2018 03:33:02 PM Central Daylight Time	08/03/2018 11:43:12 AM Central Daylight Time	07/31/2018 08:34:42 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H4513	035	0	2019	East Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	036	0	1	02	01	H4513_036_0	4	1				08/02/2018	2019.01	08/02/2018 04:13:16 PM Central Daylight Time	08/03/2018 11:43:35 AM Central Daylight Time	07/31/2018 08:34:55 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H4513	036	0	2019	Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	037	0	1	01	01	H4513_037_0	4	1				08/02/2018	2019.01	08/02/2018 04:13:43 PM Central Daylight Time	08/03/2018 01:56:29 PM Central Daylight Time	07/31/2018 08:35:09 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred KNX (HMO)	01	01		1			H4513	037	0	2019	Knoxville		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	038	0	1	01	01	H4513_038_0	4	1				08/02/2018	2019.01	08/02/2018 04:14:13 PM Central Daylight Time	08/03/2018 01:56:50 PM Central Daylight Time	07/31/2018 08:35:22 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred AR (HMO)	01	01		1			H4513	038	0	2019	Arkansas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	039	0	1	01	01	H4513_039_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 04:14:39 PM Central Daylight Time	08/03/2018 01:57:13 PM Central Daylight Time	07/31/2018 08:35:37 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare AR (HMO SNP)	01	01		1			H4513	039	0	2019	Arkansas		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	040	0	1	01	01	H4513_040_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 04:15:00 PM Central Daylight Time	08/03/2018 01:57:36 PM Central Daylight Time	07/31/2018 08:48:07 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare ETN (HMO SNP)	01	01		1			H4513	040	0	2019	East Tennessee		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	042	0	1	01	01	H4513_042_0	4	1				08/02/2018	2019.01	08/02/2018 04:15:23 PM Central Daylight Time	08/03/2018 01:57:59 PM Central Daylight Time	07/31/2018 08:48:20 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Alliance Direct (HMO)	01	01		1			H4513	042	0	2019	Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	043	0	1	01	01	H4513_043_0	4	1				07/20/2018	2019.01	07/20/2018 03:35:59 PM Central Daylight Time	08/03/2018 01:58:23 PM Central Daylight Time	07/31/2018 08:48:33 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus Direct (HMO)	01	01		1			H4513	043	0	2019	Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	044	0	1	01	01	H4513_044_0	4	1	2	1		07/20/2018	2019.01	07/20/2018 03:36:10 PM Central Daylight Time	08/03/2018 09:06:03 AM Central Daylight Time	07/31/2018 08:48:48 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4513	044	0	2019	Alabama		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	045	0	1	01	01	H4513_045_0	3	1				07/20/2018	2019.01	07/20/2018 03:36:23 PM Central Daylight Time	07/16/2018 10:30:14 AM Central Daylight Time				07/22/2018 09:38:24 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4513	045	0	2019	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	046	1	1	01	01	H4513_046_1	4	1				08/01/2018	2019.01	08/01/2018 05:05:48 PM Central Daylight Time	08/03/2018 09:06:47 AM Central Daylight Time	07/31/2018 08:53:04 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	046	1	2019	Alabama	Alabama Preferred	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	046	2	1	01	01	H4513_046_2	4	1				08/01/2018	2019.01	08/01/2018 05:06:19 PM Central Daylight Time	08/03/2018 09:07:08 AM Central Daylight Time	07/31/2018 08:53:18 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	046	2	2019	Alabama	Alabama Preferred Select Counties	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	047	0	1	01	01	H4513_047_0	4	1				08/01/2018	2019.01	08/01/2018 05:06:39 PM Central Daylight Time	08/03/2018 09:07:31 AM Central Daylight Time	07/31/2018 08:49:01 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus Direct (HMO)	01	01		1			H4513	047	0	2019	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	048	0	1	01	01	H4513_048_0	4	1				08/01/2018	2019.01	08/01/2018 05:06:56 PM Central Daylight Time	08/03/2018 09:07:53 AM Central Daylight Time	07/31/2018 08:49:14 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus Direct (HMO)	01	01		1			H4513	048	0	2019	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	049	1	1	01	01	H4513_049_1	4	1				08/02/2018	2019.01	08/02/2018 04:15:46 PM Central Daylight Time	08/03/2018 01:58:46 PM Central Daylight Time	07/31/2018 08:53:31 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	049	1	2019	Tennessee	Tennessee Preferred	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	049	2	1	01	01	H4513_049_2	4	1				08/02/2018	2019.01	08/02/2018 04:16:09 PM Central Daylight Time	08/03/2018 01:59:08 PM Central Daylight Time	07/31/2018 08:53:44 PM Central Daylight Time			08/06/2018 10:59:07 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	049	2	2019	Tennessee	Tennessee Preferred Select Counties	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	804	0	1	01	01	H4513_804_0	1	1				05/22/2018	2019.01	05/22/2018 03:20:10 PM Central Daylight Time					05/31/2018 03:37:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H4513	804	0	2019	Nationwide		1	8256	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	813	0	1	02	01	H4513_813_0	1	1				05/22/2018	2019.01	05/22/2018 03:21:11 PM Central Daylight Time					05/31/2018 03:37:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H4513	813	0	2019	Nationwide		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1				
H4513	815	0	1	01	01	H4513_815_0	1	1				05/26/2018	2019.01	05/26/2018 12:36:02 PM Central Daylight Time					05/31/2018 03:37:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H4513	815	0	2019	Tennessee, Mississippi,  & Illinois		1	16836	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1					1				
H4513	816	0	1	02	01	H4513_816_0	1	1				05/26/2018	2019.01	05/26/2018 12:42:59 PM Central Daylight Time					05/31/2018 03:37:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H4513	816	0	2019	Tennessee, Mississippi,  & Illinois		1	60	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1				
H4513	817	0	1	01	01	H4513_817_0	1	1				05/26/2018	2019.01	05/26/2018 12:50:34 PM Central Daylight Time					05/31/2018 03:37:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H4513	817	0	2019	Alabama		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1					1				
H4513	818	0	1	02	01	H4513_818_0	1	1				05/26/2018	2019.01	05/26/2018 12:23:57 PM Central Daylight Time					05/31/2018 03:37:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H4513	818	0	2019	Alabama		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1				
H4514	001	0	1	01	01	H4514_001_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 02:00:55 PM Central Daylight Time	08/03/2018 10:39:05 AM Central Daylight Time	07/31/2018 07:06:40 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4514	001	0	2019	Houston and Austin Metro areas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4514	007	0	1	01	01	H4514_007_0	3	1				08/02/2018	2019.01	08/02/2018 01:06:55 PM Central Daylight Time	08/03/2018 10:39:31 AM Central Daylight Time	07/31/2018 07:07:02 PM Central Daylight Time			08/06/2018 09:20:41 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H4514	007	0	2019	Houston Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4514	801	0	1	01	01	H4514_801_0	1	1				05/25/2018	2019.01	05/25/2018 04:22:58 PM Central Daylight Time					06/02/2018 12:41:37 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	801	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H4514	803	0	1	01	01	H4514_803_0	1	1				05/25/2018	2019.01	05/25/2018 04:23:15 PM Central Daylight Time					06/02/2018 12:41:37 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	803	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H4514	806	0	1	01	01	H4514_806_0	1	1				05/25/2018	2019.01	05/25/2018 04:23:57 PM Central Daylight Time					06/02/2018 12:41:37 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	806	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H4517	001	0	1	20	08	H4517_001_0	1	1				05/21/2018	2019.01	05/21/2018 08:40:52 AM Central Daylight Time		05/21/2018 08:38:56 AM Central Daylight Time			05/21/2018 08:43:18 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The Basics at Jan Werner	www.janwerneradultdaycare.org	DUAL ELIGIBLE (PACE)	08	20		1			H4517	001	0	2019	Potter, TX and Randall, TX Counties		2		2			2						N/A	N/A										(888)299-6401		(806)374-8400		(888)299-6401		(806)374-5516										(800)735-2989		(806)374-8400		(800)735-2989		(806)374-5516																
H4517	002	0	1	20	08	H4517_002_0	1	1				05/21/2018	2019.01	05/21/2018 08:41:06 AM Central Daylight Time		05/21/2018 08:38:28 AM Central Daylight Time			05/21/2018 08:43:18 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The Basics at Jan Werner	www.janwerneradultdaycare.org	MEDICARE ONLY (PACE)	08	20		1			H4517	002	0	2019	Potter, TX and Randall, TX Counties		2		2			2						N/A	N/A										(888)299-6401		(806)374-8400		(888)299-6401		(806)374-5516										(800)735-2989		(806)374-8400		(800)735-2989		(806)374-5516																
H4518	001	0	1	20	08	H4518_001_0	2	1				06/04/2018	2019.01	06/04/2018 04:28:27 PM Mountain Daylight Time		06/04/2018 04:06:30 PM Mountain Daylight Time			06/04/2018 04:31:23 PM Mountain Daylight Time	BIENVIVIR SENIOR HEALTH SERVICES	Bienvivir Senior Health Services	www.Bienvivir.org	BSHS Part D, Dual Eligibles (PACE)	08	20		1			H4518	001	0	2019	El Paso, Texas and El Paso County		2		2			2						www.bienvivir.org	www.bienvivir.org										(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801															
H4518	002	0	1	20	08	H4518_002_0	2	1				06/04/2018	2019.01	06/04/2018 04:29:27 PM Mountain Daylight Time		06/04/2018 04:06:33 PM Mountain Daylight Time			06/04/2018 04:31:23 PM Mountain Daylight Time	BIENVIVIR SENIOR HEALTH SERVICES	Bienvivir Senior Health Services	www.Bienvivir.org	BSHS Part D, Medicare Only (PACE)	08	20		1			H4518	002	0	2019	El Paso, Texas and El Paso County		2		2			2						www.bienvivir.org	www.bienvivir.org										(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801															
H4523	001	0	1	01	01	H4523_001_0	4	1				08/02/2018	2019.01	08/02/2018 10:29:01 AM Central Daylight Time	08/02/2018 04:11:51 PM Eastern Daylight Time	07/31/2018 11:07:34 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	001	0	2019	South Central Texas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	015	0	1	01	01	H4523_015_0	3	1				08/02/2018	2019.01	08/02/2018 10:30:41 AM Central Daylight Time	08/02/2018 04:12:33 PM Eastern Daylight Time	07/31/2018 11:08:26 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	015	0	2019	Southeast Texas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	020	0	1	01	01	H4523_020_0	3	1				08/02/2018	2019.01	08/02/2018 10:31:50 AM Central Daylight Time	08/02/2018 04:13:13 PM Eastern Daylight Time	07/31/2018 11:09:20 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	020	0	2019	Bexar and Comal counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	021	0	1	01	01	H4523_021_0	3	1				08/02/2018	2019.01	08/02/2018 10:32:11 AM Central Daylight Time	08/02/2018 04:13:53 PM Eastern Daylight Time	07/31/2018 11:10:16 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	021	0	2019	Collin, Dallas, Denton, Parker,  Tarrant Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	024	0	1	01	01	H4523_024_0	3	1				08/02/2018	2019.01	08/02/2018 10:32:29 AM Central Daylight Time	08/02/2018 04:14:35 PM Eastern Daylight Time	07/31/2018 11:11:04 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	024	0	2019	Harris, Montgomery, Fort Bend, Jefferson, Orange		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	801	0	1	01	01	H4523_801_0	3	1				06/04/2018	2019.01	06/04/2018 11:59:02 AM Eastern Daylight Time					06/04/2018 12:11:45 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4523	801	0	2019	Texas		1	780	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H4523	802	0	1	01	01	H4523_802_0	3	1				06/04/2018	2019.01	06/04/2018 12:00:02 PM Eastern Daylight Time					06/04/2018 12:11:45 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H4523	802	0	2019	Texas		1	5970	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H4527	001	0	1	01	01	H4527_001_0	3	1				08/02/2018	2019.01	08/02/2018 01:09:57 PM Central Daylight Time	08/03/2018 10:22:55 AM Central Daylight Time	07/31/2018 07:07:26 PM Central Daylight Time			08/06/2018 09:27:32 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	001	0	2019	Select Counties in Texas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	002	0	1	01	01	H4527_002_0	3	1				08/02/2018	2019.01	08/02/2018 01:10:36 PM Central Daylight Time	08/03/2018 09:54:44 AM Central Daylight Time	07/31/2018 07:07:48 PM Central Daylight Time			08/06/2018 09:27:32 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	002	0	2019	Bastrop, Hays, Travis, and Williamson counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	003	0	1	01	01	H4527_003_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 10:34:36 AM Central Daylight Time	08/03/2018 09:55:21 AM Central Daylight Time	07/31/2018 07:08:12 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	003	0	2019	Hays, Travis, and Williamson counties		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	004	0	1	01	01	H4527_004_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 10:34:49 AM Central Daylight Time	08/03/2018 09:55:59 AM Central Daylight Time	07/31/2018 07:08:36 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	004	0	2019	Aransas, Kleberg, Nueces, San Patricio counties		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	005	0	1	01	01	H4527_005_0	3	1				08/02/2018	2019.01	08/02/2018 01:11:09 PM Central Daylight Time	08/03/2018 09:56:37 AM Central Daylight Time	07/31/2018 07:09:00 PM Central Daylight Time			08/06/2018 09:27:32 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	005	0	2019	El Paso County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	006	0	1	01	01	H4527_006_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 10:35:05 AM Central Daylight Time	08/03/2018 09:57:16 AM Central Daylight Time	07/31/2018 07:09:24 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	006	0	2019	El Paso County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	013	0	1	01	01	H4527_013_0	3	1				08/02/2018	2019.01	08/02/2018 01:14:47 PM Central Daylight Time	08/03/2018 09:57:54 AM Central Daylight Time	07/31/2018 07:09:48 PM Central Daylight Time			08/06/2018 09:27:32 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	013	0	2019	Brownsville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	015	0	1	01	01	H4527_015_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 10:35:19 AM Central Daylight Time	08/03/2018 09:58:32 AM Central Daylight Time	07/31/2018 07:10:12 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	015	0	2019	Cameron, Hidalgo, and Willacy counties		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	024	0	1	01	01	H4527_024_0	2	1				07/12/2018	2019.01	07/12/2018 11:51:52 AM Central Daylight Time	06/01/2018 03:55:23 PM Central Daylight Time				07/13/2018 09:00:06 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus Essential (HMO)	01	01		1			H4527	024	0	2019	Select counties in Texas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4527	037	0	1	01	01	H4527_037_0	3	1				08/02/2018	2019.01	08/02/2018 01:16:22 PM Central Daylight Time	08/03/2018 09:59:50 AM Central Daylight Time	07/31/2018 07:10:34 PM Central Daylight Time			08/06/2018 09:27:32 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H4527	037	0	2019	Houston Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	038	0	1	01	01	H4527_038_0	4	1				08/02/2018	2019.01	08/02/2018 01:19:34 PM Central Daylight Time	08/03/2018 10:00:37 AM Central Daylight Time	07/31/2018 07:10:58 PM Central Daylight Time			08/06/2018 09:27:32 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4527	038	0	2019	Bell, Falls, Hill, and McLennan counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	801	0	1	01	01	H4527_801_0	2	1				05/23/2018	2019.01	05/23/2018 10:52:28 AM Central Daylight Time					06/02/2018 12:44:17 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	801	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4527	802	0	1	01	01	H4527_802_0	2	1				05/23/2018	2019.01	05/23/2018 10:54:34 AM Central Daylight Time					06/02/2018 12:44:17 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	802	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4527	803	0	1	01	01	H4527_803_0	2	1				05/23/2018	2019.01	05/23/2018 10:56:49 AM Central Daylight Time					06/02/2018 12:44:17 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	803	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4590	010	0	1	01	01	H4590_010_0	3	1				08/02/2018	2019.01	08/02/2018 01:20:15 PM Central Daylight Time	08/03/2018 10:01:17 AM Central Daylight Time	07/31/2018 07:11:20 PM Central Daylight Time			08/06/2018 09:35:07 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	010	0	2019	San Antonio Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	012	0	1	01	01	H4590_012_0	3	1				08/02/2018	2019.01	08/02/2018 01:20:48 PM Central Daylight Time	08/03/2018 10:01:54 AM Central Daylight Time	07/31/2018 07:11:42 PM Central Daylight Time			08/06/2018 09:35:07 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H4590	012	0	2019	Dallas/Fort Worth Metroplex		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	020	0	1	01	01	H4590_020_0	3	1	2	1		05/29/2018	2019.01	05/29/2018 10:39:32 AM Central Daylight Time	08/03/2018 10:02:35 AM Central Daylight Time	07/31/2018 07:12:08 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	020	0	2019	Dallas/Ft Worth Metroplex		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	022	0	1	01	01	H4590_022_0	3	1	2	1		05/31/2018	2019.01	05/31/2018 02:26:54 PM Central Daylight Time	08/03/2018 10:03:13 AM Central Daylight Time	07/31/2018 07:12:32 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	022	0	2019	San Antonio Metro area		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	025	0	1	01	01	H4590_025_0	3	1				08/02/2018	2019.01	08/02/2018 01:22:26 PM Central Daylight Time	08/03/2018 10:03:52 AM Central Daylight Time	07/31/2018 07:12:54 PM Central Daylight Time			08/06/2018 09:35:07 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	025	0	2019	Corpus Christi Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	027	0	1	01	01	H4590_027_0	2	1				07/12/2018	2019.01	07/12/2018 12:27:00 PM Central Daylight Time	06/01/2018 04:01:46 PM Central Daylight Time				07/13/2018 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H4590	027	0	2019	Dallas/Ft Worth Metroplex		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4590	029	0	1	01	01	H4590_029_0	1	1				05/25/2018	2019.01	05/25/2018 10:41:58 AM Central Daylight Time	06/01/2018 04:02:13 PM Central Daylight Time				06/02/2018 12:46:59 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H4590	029	0	2019	San Antonio Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4590	033	0	1	01	01	H4590_033_0	3	1	2	1		05/30/2018	2019.01	05/30/2018 12:49:09 PM Central Daylight Time	08/03/2018 10:05:51 AM Central Daylight Time	07/31/2018 07:13:18 PM Central Daylight Time			08/07/2018 08:39:28 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	033	0	2019	Corpus Christi metro area		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	037	0	1	01	01	H4590_037_0	3	1		1		08/02/2018	2019.01	08/02/2018 01:24:12 PM Central Daylight Time	08/03/2018 10:06:28 AM Central Daylight Time	07/31/2018 07:13:42 PM Central Daylight Time			08/06/2018 09:35:07 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO SNP)	01	01		1			H4590	037	0	2019	San Antonio Metro Area		2		2			1	4			00011010000000000000		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(800)555-5757		(800)555-5757		(866)846-2762		(866)846-2762		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	041	0	1	01	01	H4590_041_0	3	1				07/12/2018	2019.01	07/12/2018 12:29:18 PM Central Daylight Time	08/03/2018 10:07:08 AM Central Daylight Time	07/31/2018 07:14:04 PM Central Daylight Time			08/06/2018 09:35:07 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H4590	041	0	2019	Dallas/Ft Worth Metroplex		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	042	0	1	01	01	H4590_042_0	4	1				08/02/2018	2019.01	08/02/2018 01:26:11 PM Central Daylight Time	08/03/2018 10:07:46 AM Central Daylight Time	07/31/2018 07:14:26 PM Central Daylight Time			08/06/2018 09:35:07 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4590	042	0	2019	Select Counties in Texas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	801	0	1	01	01	H4590_801_0	1	1				05/23/2018	2019.01	05/23/2018 11:00:40 AM Central Daylight Time					06/02/2018 12:47:25 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	801	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4590	803	0	1	01	01	H4590_803_0	1	1				05/23/2018	2019.01	05/23/2018 11:03:39 AM Central Daylight Time					06/02/2018 12:47:25 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	803	0	2019	TX Employer Sponsored Plan Service Area		1	20736	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4590	804	0	1	01	01	H4590_804_0	1	1				05/23/2018	2019.01	05/23/2018 11:05:21 AM Central Daylight Time					06/02/2018 12:47:25 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	804	0	2019	TX Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4604	003	0	1	01	01	H4604_003_0	3	1				07/12/2018	2019.01	07/12/2018 12:36:41 PM Central Daylight Time	08/03/2018 10:08:24 AM Central Daylight Time	07/31/2018 07:14:50 PM Central Daylight Time			08/06/2018 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H4604	003	0	2019	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	005	0	1	01	01	H4604_005_0	1	1				05/13/2018	2019.01	05/13/2018 08:52:41 PM Central Daylight Time	06/01/2018 04:06:53 PM Central Daylight Time				06/02/2018 01:37:47 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H4604	005	0	2019	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4604	011	0	1	01	01	H4604_011_0	3	1				08/02/2018	2019.01	08/02/2018 02:16:24 PM Central Daylight Time	08/03/2018 10:09:44 AM Central Daylight Time	07/31/2018 07:15:12 PM Central Daylight Time			08/06/2018 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H4604	011	0	2019	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	012	0	1	01	01	H4604_012_0	4	1				07/12/2018	2019.01	07/12/2018 12:37:27 PM Central Daylight Time	08/03/2018 10:10:21 AM Central Daylight Time	07/31/2018 07:15:34 PM Central Daylight Time			08/06/2018 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4604	012	0	2019	Ada, Canyon, Gem, and Payette Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	013	0	1	01	01	H4604_013_0	3	1				05/24/2018	2019.01	05/24/2018 04:53:35 PM Central Daylight Time	08/03/2018 10:11:02 AM Central Daylight Time	07/31/2018 07:15:58 PM Central Daylight Time			08/06/2018 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4604	013	0	2019	Bonner and Kootenai Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	014	0	1	01	01	H4604_014_0	3	1				05/24/2018	2019.01	05/24/2018 12:28:47 PM Central Daylight Time	08/03/2018 10:11:39 AM Central Daylight Time	07/31/2018 07:16:22 PM Central Daylight Time			08/06/2018 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4604	014	0	2019	Bannock, Bonneville, and Twin Falls Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	801	0	1	01	01	H4604_801_0	1	1				05/30/2018	2019.01	05/30/2018 04:34:39 PM Central Daylight Time					06/02/2018 03:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	801	0	2019	Salt Lake and Surrounding Counties		1	300	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H4604	803	0	1	01	01	H4604_803_0	1	1				05/30/2018	2019.01	05/30/2018 04:35:27 PM Central Daylight Time					06/02/2018 03:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	803	0	2019	Select Counties In UT		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H4604	805	0	1	01	01	H4604_805_0	1	1				05/30/2018	2019.01	05/30/2018 04:36:09 PM Central Daylight Time					06/02/2018 03:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	805	0	2019	Select counties in UT		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H4605	001	0	1	04	01	H4605_001_0	6	1				07/18/2018	2019.01	07/18/2018 06:01:49 PM Mountain Daylight Time	07/19/2018 07:01:24 PM Mountain Daylight Time				07/20/2018 03:58:30 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H4605	001	0	2019	Davis, Salt Lake, Utah, and Weber counties		2	6780	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4605	002	0	1	04	01	H4605_002_0	8	1				07/18/2018	2019.01	07/18/2018 06:08:56 PM Mountain Daylight Time	08/01/2018 11:26:43 PM Mountain Daylight Time	08/01/2018 11:27:24 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H4605	002	0	2019	Davis, Salt Lake, Utah, and Weber counties		2	58134	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4605	004	0	1	04	01	H4605_004_0	9	1				07/18/2018	2019.01	07/18/2018 06:15:57 PM Mountain Daylight Time	08/01/2018 11:28:18 PM Mountain Daylight Time	08/01/2018 11:28:57 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H4605	004	0	2019	Davis, Salt Lake, Utah, and Weber counties		2	23088	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4605	007	0	1	04	01	H4605_007_0	8	1				07/18/2018	2019.01	07/18/2018 06:25:35 PM Mountain Daylight Time	08/01/2018 11:29:51 PM Mountain Daylight Time	08/01/2018 11:30:31 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H4605	007	0	2019	Davis, Salt Lake, Utah, and Weber counties		2	11438	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4605	801	0	1	04	01	H4605_801_0	1	1				05/15/2018	2019.01	05/15/2018 11:42:09 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H4605	801	0	2019	Nationwide except territories		1	27810	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4605	802	0	1	04	01	H4605_802_0	1	1				05/18/2018	2019.01	05/18/2018 11:18:14 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H4605	802	0	2019	Nationwide except territories		1	2569	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4605	803	0	1	04	01	H4605_803_0	1	1				05/18/2018	2019.01	05/18/2018 11:18:27 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	01	04		1			H4605	803	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4605	804	0	1	04	01	H4605_804_0	1	1				05/18/2018	2019.01	05/18/2018 11:19:40 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	01	04		1			H4605	804	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4623	001	0	1	01	01	H4623_001_0	3	1				07/03/2018	2019.01	07/03/2018 01:08:18 PM Eastern Daylight Time	06/01/2018 02:50:36 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4623-001 (HMO)	01	01		1			H4623	001	0	2019	Southwest Missouri		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4714	001	0	1	20	08	H4714_001_0	1	1				06/01/2018	2019.01	06/01/2018 03:57:10 PM Eastern Daylight Time		06/01/2018 04:11:28 PM Eastern Daylight Time			06/01/2018 04:12:45 PM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont, Inc.	www.pacesp.com	PACE of  the Southern Piedmont - Dual (PACE)	08	20		1			H4714	001	0	2019	PACE of  the Southern Piedmont - Dual		2		2			2						www.seniorscript.com	Not applicable										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840																
H4714	002	0	1	20	08	H4714_002_0	1	1				06/01/2018	2019.01	06/01/2018 03:57:31 PM Eastern Daylight Time		06/01/2018 04:11:19 PM Eastern Daylight Time			06/01/2018 04:12:45 PM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont, Inc.	www.pacesp.com	PACE of  the Southern Piedmont - Medicare only (PACE)	08	20		1			H4714	002	0	2019	PACE of  the Southern Piedmont - Medicare only		2		2			2						www.seniorscript.com	Not applicable										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840																
H4754	004	0	1	04	01	H4754_004_0	5	1				07/13/2018	2019.01	07/13/2018 07:47:27 AM Pacific Daylight Time	08/01/2018 02:16:18 PM Pacific Daylight Time	08/01/2018 10:49:14 AM Pacific Daylight Time			08/03/2018 08:16:41 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 4 (PPO)	01	04		1			H4754	004	0	2019	Lane County		2	7144	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H4754	006	0	1	04	01	H4754_006_0	2	1				07/13/2018	2019.01	07/13/2018 07:47:20 AM Pacific Daylight Time	07/13/2018 10:26:59 AM Pacific Daylight Time				07/13/2018 10:30:25 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 6 (PPO)	01	04		1			H4754	006	0	2019	Southwest and Southern Idaho		2	13689	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H4754	007	0	1	04	01	H4754_007_0	6	1				07/13/2018	2019.01	07/13/2018 07:47:12 AM Pacific Daylight Time	08/01/2018 09:51:08 AM Pacific Daylight Time	08/01/2018 10:50:14 AM Pacific Daylight Time			08/03/2018 08:16:41 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 7 (PPO)	01	04		1			H4754	007	0	2019	Coos and Curry Counties		2	6030	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H4754	008	0	1	04	01	H4754_008_0	2	1				07/13/2018	2019.01	07/13/2018 07:47:01 AM Pacific Daylight Time	07/13/2018 10:01:22 AM Pacific Daylight Time				07/13/2018 10:30:25 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 8 (PPO)	01	04		1			H4754	008	0	2019	Coos, Curry and Lane Counties		2	2987	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H4754	009	0	1	04	01	H4754_009_0	5	1				07/13/2018	2019.01	07/13/2018 07:46:03 AM Pacific Daylight Time	08/01/2018 09:52:46 AM Pacific Daylight Time	08/01/2018 10:51:12 AM Pacific Daylight Time			08/03/2018 08:16:41 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 9 (PPO)	01	04		1			H4754	009	0	2019	Eastern Idaho		2	43120	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H4754	011	0	1	04	01	H4754_011_0	6	1				07/13/2018	2019.01	07/13/2018 07:46:53 AM Pacific Daylight Time	08/01/2018 02:18:40 PM Pacific Daylight Time	08/01/2018 10:52:14 AM Pacific Daylight Time			08/03/2018 08:16:41 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 11 (PPO)	01	04		1			H4754	011	0	2019	North Idaho		2	71016	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H4754	012	0	1	04	01	H4754_012_0	2	1				07/13/2018	2019.01	07/13/2018 07:46:43 AM Pacific Daylight Time	07/13/2018 10:27:48 AM Pacific Daylight Time				07/13/2018 10:30:25 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 12 (PPO)	01	04		1			H4754	012	0	2019	North and Eastern Idaho		2	11090	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H4754	801	0	1	04	01	H4754_801_0	1	1				06/02/2018	2019.01	06/02/2018 12:53:08 PM Pacific Daylight Time					06/03/2018 12:27:30 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 801 (PPO)	01	04		1			H4754	801	0	2019	Statewide - Idaho and Oregon		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H4754	802	0	1	04	01	H4754_802_0	1	1				06/02/2018	2019.01	06/02/2018 12:53:15 PM Pacific Daylight Time					06/03/2018 12:27:30 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 802 (PPO)	01	04		1			H4754	802	0	2019	Statewide - Idaho and Oregon		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H4778	001	0	1	01	01	H4778_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:49:17 AM Eastern Daylight Time	08/07/2018 02:52:08 PM Eastern Daylight Time	08/07/2018 02:52:08 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN IL, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan I-SNP (HMO SNP)	01	01		1			H4778	001	0	2019	Illinois (partial)		2	1436	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4778	002	0	1	01	01	H4778_002_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:50:27 AM Eastern Daylight Time	08/07/2018 02:52:08 PM Eastern Daylight Time	08/07/2018 02:52:09 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN IL, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan C-SNP (HMO SNP)	01	01		1			H4778	002	0	2019	Illinois (partial)		2	1518	2			1	4			00000100000000000000		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4778	003	0	1	01	01	H4778_003_0	4	1				08/03/2018	2019.01	08/03/2018 09:50:57 AM Eastern Daylight Time	08/07/2018 02:52:09 PM Eastern Daylight Time	08/07/2018 02:52:09 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN IL, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO)	01	01		1			H4778	003	0	2019	Illinois (partial)		2	328	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4778	004	0	1	01	01	H4778_004_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:51:57 AM Eastern Daylight Time	08/07/2018 02:52:09 PM Eastern Daylight Time	08/07/2018 02:52:10 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN IL, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan Gold (HMO SNP)	01	01		1			H4778	004	0	2019	Illinois (partial)		2	821	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	001	0	1	01	01	H4847_001_0	4	1				08/03/2018	2019.01	08/03/2018 01:14:03 PM Eastern Daylight Time	08/06/2018 05:30:23 PM Eastern Daylight Time	08/01/2018 02:34:40 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	WELLCARE	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H4847	001	0	2019	Selected SC Counties		2	32909	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	002	0	1	01	01	H4847_002_0	4	1				08/03/2018	2019.01	08/03/2018 01:13:01 PM Eastern Daylight Time	08/06/2018 05:31:08 PM Eastern Daylight Time	08/01/2018 02:35:01 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	WELLCARE	www.wellcare.com/medicare	WellCare Elite (HMO)	01	01		1			H4847	002	0	2019	Select SC Counties		2	4568	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	001	0	1	01	01	H4853_001_0	9	1				06/04/2018	2019.01	06/04/2018 05:02:43 PM Central Daylight Time	08/02/2018 01:28:48 PM Central Daylight Time	08/02/2018 11:09:30 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage (HMO)	01	01		1			H4853	001	0	2019	Maricopa County		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	002	0	1	01	01	H4853_002_0	9	1				06/04/2018	2019.01	06/04/2018 05:03:22 PM Central Daylight Time	08/06/2018 09:42:29 AM Central Daylight Time	08/02/2018 11:10:12 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Plus (HMO)	01	01		1			H4853	002	0	2019	Maricopa County		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	003	0	1	02	01	H4853_003_0	9	1				06/04/2018	2019.01	06/04/2018 05:05:24 PM Central Daylight Time	08/02/2018 01:30:38 PM Central Daylight Time	08/02/2018 11:10:52 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Choice (HMO-POS)	01	02		1			H4853	003	0	2019	Maricopa County		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	004	0	1	02	01	H4853_004_0	9	1				06/04/2018	2019.01	06/04/2018 05:06:00 PM Central Daylight Time	08/02/2018 01:31:36 PM Central Daylight Time	08/02/2018 11:11:30 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Choice Plus (HMO-POS)	01	02		1			H4853	004	0	2019	Maricopa County		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	001	0	1	01	01	H4868_001_0	3	1				08/07/2018	2019.01	08/07/2018 01:59:58 PM Eastern Daylight Time	08/06/2018 05:31:53 PM Eastern Daylight Time	08/01/2018 02:35:21 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Today's Options Classic (HMO)	01	01		1			H4868	001	0	2019	Select counties in New York		2	3699	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	002	0	1	01	01	H4868_002_0	5	1	2	1		07/12/2018	2019.01	07/12/2018 04:15:19 PM Eastern Daylight Time	08/06/2018 05:32:38 PM Eastern Daylight Time	08/01/2018 02:35:42 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H4868	002	0	2019	Select Counties in NY		2	26835	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	003	0	1	01	01	H4868_003_0	3	1				05/30/2018	2019.01	05/30/2018 04:12:30 PM Eastern Daylight Time	06/02/2018 02:57:18 AM Eastern Daylight Time				06/02/2018 01:11:50 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Advance (HMO)	01	01		1			H4868	003	0	2019	Select Counties in NY		2	3836	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4868	004	0	1	01	01	H4868_004_0	5	1	2	1		07/12/2018	2019.01	07/12/2018 04:19:06 PM Eastern Daylight Time	08/06/2018 05:34:09 PM Eastern Daylight Time	08/01/2018 02:36:03 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H4868	004	0	2019	Select Counties in NY		2	24208	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	005	3	1	01	01	H4868_005_3	4	1	2	1		07/12/2018	2019.01	07/12/2018 04:21:54 PM Eastern Daylight Time	08/06/2018 06:54:41 PM Eastern Daylight Time	08/01/2018 02:36:24 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H4868	005	3	2019	Select Counties in NY	select counties	2	142802	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	005	4	1	01	01	H4868_005_4	5	1	2	1		07/12/2018	2019.01	07/12/2018 04:30:16 PM Eastern Daylight Time	08/06/2018 06:56:13 PM Eastern Daylight Time	08/01/2018 02:36:45 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H4868	005	4	2019	Select Counties in NY	select counties	2	42801	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	006	3	1	01	01	H4868_006_3	4	1				07/12/2018	2019.01	07/12/2018 04:31:53 PM Eastern Daylight Time	08/06/2018 06:57:47 PM Eastern Daylight Time	08/01/2018 02:37:06 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H4868	006	3	2019	Select Counties in NY	select counties	2	39380	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	006	4	1	01	01	H4868_006_4	4	1				07/13/2018	2019.01	07/13/2018 09:28:47 AM Eastern Daylight Time	08/06/2018 06:59:39 PM Eastern Daylight Time	08/01/2018 02:37:27 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H4868	006	4	2019	Select Counties in NY	select counties	2	43408	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	007	0	1	01	01	H4868_007_0	3	1				08/03/2018	2019.01	08/03/2018 11:56:03 AM Eastern Daylight Time	08/06/2018 05:37:45 PM Eastern Daylight Time	08/01/2018 02:37:47 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Choice (HMO)	01	01		1			H4868	007	0	2019	Select Counties in NY		2	6277	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	008	0	1	01	01	H4868_008_0	3	1				08/03/2018	2019.01	08/03/2018 11:56:36 AM Eastern Daylight Time	08/06/2018 05:38:28 PM Eastern Daylight Time	08/01/2018 02:38:08 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Choice (HMO)	01	01		1			H4868	008	0	2019	Select Counties in NY		2	5334	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	009	0	1	01	01	H4868_009_0	3	1				08/03/2018	2019.01	08/03/2018 11:57:09 AM Eastern Daylight Time	08/06/2018 05:39:11 PM Eastern Daylight Time	08/01/2018 02:38:31 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Essential (HMO)	01	01		1			H4868	009	0	2019	Select Counties in NY		2	28541	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	010	0	1	01	01	H4868_010_0	3	1				08/03/2018	2019.01	08/03/2018 11:57:38 AM Eastern Daylight Time	08/06/2018 05:39:53 PM Eastern Daylight Time	08/01/2018 02:38:52 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Preferred (HMO)	01	01		1			H4868	010	0	2019	Select Counties in NY		2	5662	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	011	1	1	01	01	H4868_011_1	3	1				08/07/2018	2019.01	08/07/2018 02:03:24 PM Eastern Daylight Time	08/07/2018 01:43:06 PM Eastern Daylight Time	08/01/2018 02:39:13 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H4868	011	1	2019	Select Counties in NY	select counties	2	13445	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	011	2	1	01	01	H4868_011_2	3	1				08/03/2018	2019.01	08/03/2018 11:59:23 AM Eastern Daylight Time	08/06/2018 05:41:19 PM Eastern Daylight Time	08/01/2018 02:39:34 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H4868	011	2	2019	Select Counties in NY	select counties	2	36281	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	012	1	1	01	01	H4868_012_1	3	1				08/03/2018	2019.01	08/03/2018 12:01:07 PM Eastern Daylight Time	08/06/2018 05:42:00 PM Eastern Daylight Time	08/01/2018 02:39:56 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Choice (HMO)	01	01		1			H4868	012	1	2019	Select Counties in NY	select counties	2	25697	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	012	2	1	01	01	H4868_012_2	3	1				08/03/2018	2019.01	08/03/2018 12:01:36 PM Eastern Daylight Time	08/06/2018 05:42:43 PM Eastern Daylight Time	08/01/2018 02:40:18 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Choice (HMO)	01	01		1			H4868	012	2	2019	Select Counties in NY	select counties	2	68327	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	013	0	1	01	01	H4868_013_0	3	1				08/03/2018	2019.01	08/03/2018 12:02:21 PM Eastern Daylight Time	08/06/2018 05:43:25 PM Eastern Daylight Time	08/01/2018 02:40:39 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H4868	013	0	2019	Select Counties in NY		2	1270	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4875	016	1	1	04	01	H4875_016_1	13	1				07/17/2018	2019.01	07/17/2018 01:31:37 PM Eastern Daylight Time	08/02/2018 03:38:34 PM Eastern Daylight Time	08/01/2018 10:17:26 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	1	2019	68 lower peninsula Michigan counties	Region 3	2	42288	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	2	1	04	01	H4875_016_2	13	1				07/17/2018	2019.01	07/17/2018 01:31:52 PM Eastern Daylight Time	08/02/2018 03:39:22 PM Eastern Daylight Time	08/01/2018 10:17:50 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	2	2019	68 lower peninsula Michigan counties	Region 4	2	21173	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	3	1	04	01	H4875_016_3	13	1				07/17/2018	2019.01	07/17/2018 01:32:07 PM Eastern Daylight Time	08/02/2018 03:40:10 PM Eastern Daylight Time	08/01/2018 10:18:12 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	3	2019	68 lower peninsula Michigan counties	Region 5	2	40095	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	4	1	04	01	H4875_016_4	13	1				07/17/2018	2019.01	07/17/2018 01:32:24 PM Eastern Daylight Time	08/02/2018 03:41:00 PM Eastern Daylight Time	08/01/2018 10:18:36 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	4	2019	68 lower peninsula Michigan counties	Region 1	2	146612	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	5	1	04	01	H4875_016_5	13	1				07/17/2018	2019.01	07/17/2018 01:32:45 PM Eastern Daylight Time	08/02/2018 03:41:50 PM Eastern Daylight Time	08/01/2018 10:19:00 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	5	2019	68 lower peninsula Michigan counties	Region 2	2	64159	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	1	1	04	01	H4875_017_1	13	1				07/17/2018	2019.01	07/17/2018 01:35:46 PM Eastern Daylight Time	08/02/2018 03:42:40 PM Eastern Daylight Time	08/01/2018 10:19:24 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	1	2019	68 lower peninsula Michigan counties	Region 1	2	24417	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	2	1	04	01	H4875_017_2	13	1				07/17/2018	2019.01	07/17/2018 01:36:01 PM Eastern Daylight Time	08/02/2018 03:43:30 PM Eastern Daylight Time	08/01/2018 10:19:48 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	2	2019	68 lower peninsula Michigan counties	Region 2	2	13341	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	3	1	04	01	H4875_017_3	13	1				07/17/2018	2019.01	07/17/2018 01:36:38 PM Eastern Daylight Time	08/02/2018 03:44:20 PM Eastern Daylight Time	08/01/2018 10:20:12 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	3	2019	68 lower peninsula Michigan counties	Region 3	2	8983	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	4	1	04	01	H4875_017_4	13	1				07/17/2018	2019.01	07/17/2018 01:36:55 PM Eastern Daylight Time	08/02/2018 03:45:08 PM Eastern Daylight Time	08/01/2018 10:20:36 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	4	2019	68 lower peninsula Michigan counties	Region 4	2	3873	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	5	1	04	01	H4875_017_5	13	1				07/17/2018	2019.01	07/17/2018 01:37:12 PM Eastern Daylight Time	08/02/2018 03:45:56 PM Eastern Daylight Time	08/01/2018 10:21:00 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	5	2019	68 lower peninsula Michigan counties	Region 5	2	6388	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	1	1	04	01	H4875_018_1	13	1				07/17/2018	2019.01	07/17/2018 01:37:29 PM Eastern Daylight Time	08/02/2018 03:46:42 PM Eastern Daylight Time	08/01/2018 10:21:24 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	1	2019	68 lower peninsula Michigan counties	Region 1	2	3716	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	2	1	04	01	H4875_018_2	13	1				07/17/2018	2019.01	07/17/2018 01:37:44 PM Eastern Daylight Time	08/02/2018 03:47:28 PM Eastern Daylight Time	08/01/2018 10:21:48 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	2	2019	68 lower peninsula Michigan counties	Region 2	2	20990	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	3	1	04	01	H4875_018_3	13	1				07/17/2018	2019.01	07/17/2018 01:38:04 PM Eastern Daylight Time	08/02/2018 03:48:14 PM Eastern Daylight Time	08/01/2018 10:22:12 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	3	2019	68 lower peninsula Michigan counties	Region 3	2	18036	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	4	1	04	01	H4875_018_4	13	1				07/17/2018	2019.01	07/17/2018 01:38:24 PM Eastern Daylight Time	08/02/2018 03:48:58 PM Eastern Daylight Time	08/01/2018 10:22:36 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	4	2019	68 lower peninsula Michigan counties	Region 4	2	15585	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	5	1	04	01	H4875_018_5	13	1				07/17/2018	2019.01	07/17/2018 01:38:42 PM Eastern Daylight Time	08/02/2018 03:49:44 PM Eastern Daylight Time	08/01/2018 10:23:00 AM Eastern Daylight Time			08/07/2018 08:13:57 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	5	2019	68 lower peninsula Michigan counties	Region 5	2	37677	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(888)389-6648		(616)464-8820		(866)211-9151		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	803	0	1	04	01	H4875_803_0	9	1				07/16/2018	2019.01	07/16/2018 11:16:52 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select EG Non-Calendar Year (PPO)	01	04		1			H4875	803	0	2019	National		1	37	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	804	0	1	04	01	H4875_804_0	9	1				07/16/2018	2019.01	07/16/2018 11:17:04 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select EG Calendar Year (PPO)	01	04		1			H4875	804	0	2019	National		1	4881	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	805	0	1	04	01	H4875_805_0	9	1				07/16/2018	2019.01	07/16/2018 11:17:14 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO No RX EGWP Calendar (PPO)	01	04		1			H4875	805	0	2019	National		1	4	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4875	806	0	1	04	01	H4875_806_0	9	1				07/16/2018	2019.01	07/16/2018 11:17:29 AM Eastern Daylight Time					07/16/2018 01:29:53 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO No RX EGWP Non-Calendar (PPO)	01	04		1			H4875	806	0	2019	National		1	4	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4876	001	0	1	04	01	H4876_001_0	4	1				08/06/2018	2019.01	08/06/2018 10:03:39 AM SA Western Standard Time	08/01/2018 10:38:32 AM SA Western Standard Time	08/01/2018 10:24:54 AM SA Western Standard Time			08/06/2018 02:54:32 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Olympus Constellation Health (PPO)	01	04		1			H4876	001	0	2019	Puerto Rico		2	7523	2			2						www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2						2			
H4876	003	0	1	04	01	H4876_003_0	4	1				08/03/2018	2019.01	08/03/2018 04:09:27 PM SA Western Standard Time	08/01/2018 10:37:36 AM SA Western Standard Time	08/01/2018 10:25:34 AM SA Western Standard Time			08/06/2018 02:54:32 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Olympus Prime Constellation Health (PPO)	01	04		1			H4876	003	0	2019	Puerto Rico		2	40840	2			2						www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2						2			
H4876	801	0	1	04	01	H4876_801_0	1	1				05/26/2018	2019.01	05/26/2018 11:28:44 AM SA Western Standard Time					05/26/2018 01:44:59 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Geminis 1 Constellation Health (PPO)	01	04		1			H4876	801	0	2019	Puerto Rico		1	6448	2			2						www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2						2			
H4876	802	0	1	04	01	H4876_802_0	1	1				05/26/2018	2019.01	05/26/2018 11:28:54 AM SA Western Standard Time					05/26/2018 01:44:59 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Geminis 2 Constellation Health (PPO)	01	04		1			H4876	802	0	2019	Puerto Rico		1	6448	2			2						www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2						2			
H4882	001	0	1	04	01	H4882_001_0	6	1				07/02/2018	2019.01	07/02/2018 02:36:50 PM Central Daylight Time	08/07/2018 07:02:03 AM Central Daylight Time	08/07/2018 07:01:25 AM Central Daylight Time			08/07/2018 08:34:35 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Stride (PPO)	01	04		1			H4882	001	0	2019	Metro and Central MN Counties		2	4380	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx	healthpartners.com/medicare	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	002	0	1	04	01	H4882_002_0	6	1				07/02/2018	2019.01	07/02/2018 02:36:40 PM Central Daylight Time	08/07/2018 07:01:59 AM Central Daylight Time	08/07/2018 07:01:23 AM Central Daylight Time			08/07/2018 08:34:35 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Pace (PPO)	01	04		1			H4882	002	0	2019	Metro and Central MN Counties		2	4380	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx	healthpartners.com/medicare	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	003	0	1	04	01	H4882_003_0	6	1				07/02/2018	2019.01	07/02/2018 02:37:55 PM Central Daylight Time	08/07/2018 07:01:55 AM Central Daylight Time	08/07/2018 07:01:22 AM Central Daylight Time			08/07/2018 08:34:35 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Steady (PPO)	01	04		1			H4882	003	0	2019	Metro and Central MN Counties		2		2			2						healthpartners.com/medicare	healthpartners.com/medicarerx	healthpartners.com/medicare	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	004	0	1	04	01	H4882_004_0	7	1				07/02/2018	2019.01	07/02/2018 02:38:22 PM Central Daylight Time	08/07/2018 07:01:54 AM Central Daylight Time	08/07/2018 07:01:18 AM Central Daylight Time			08/07/2018 08:34:35 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Birch (PPO)	01	04		1			H4882	004	0	2019	Certain NE WI Counties		2		2			2						healthpartners.com/medicare	healthpartners.com/medicarerx	healthpartners.com/medicare	(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	005	0	1	04	01	H4882_005_0	8	1				07/02/2018	2019.01	07/02/2018 02:39:01 PM Central Daylight Time	08/07/2018 07:01:52 AM Central Daylight Time	08/07/2018 07:01:13 AM Central Daylight Time			08/07/2018 08:34:35 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Maple (PPO)	01	04		1			H4882	005	0	2019	Certain NE WI Counties		2		2			2						healthpartners.com/medicare	healthpartners.com/medicarerx	healthpartners.com/medicare	(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	801	0	1	04	01	H4882_801_0	1	1				06/01/2018	2019.01	06/01/2018 11:48:28 AM Central Daylight Time					06/01/2018 04:39:26 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group MAPD Calendar Year (PPO)	01	04		1			H4882	801	0	2019	All States Excluding 48 Cost Counties		1	132720	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx	healthpartners.com/medicare	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	803	0	1	04	01	H4882_803_0	1	1				06/01/2018	2019.01	06/01/2018 11:47:41 AM Central Daylight Time					06/01/2018 04:39:26 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group MA Only (PPO)	01	04		1			H4882	803	0	2019	All States Excluding 48 Cost Counties		1	0	2			2						healthpartners.com/medicare	healthpartners.com/medicarerx	healthpartners.com/medicare	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4909	014	0	1	04	01	H4909_014_0	6	1				08/03/2018	2019.01	08/03/2018 09:58:55 PM Eastern Daylight Time	08/06/2018 12:43:22 AM Eastern Daylight Time	08/01/2018 08:18:01 PM Eastern Daylight Time			08/06/2018 06:18:09 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com	Anthem MediBlue Access (PPO)	01	04		1			H4909	014	0	2019	Mathews County		2	1285	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)827-9866		(866)827-9866		(800)797-5937		(800)797-5937		(866)827-9866		(866)827-9866		(844)364-2119		(844)364-2119		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	015	0	1	04	01	H4909_015_0	8	1				08/03/2018	2019.01	08/03/2018 01:28:06 PM Eastern Daylight Time	08/06/2018 12:44:23 AM Eastern Daylight Time	08/01/2018 08:18:46 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com	Anthem MediBlue Access (PPO)	01	04		1			H4909	015	0	2019	Select Counties in Missouri		2	22944	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7798		(855)690-7798		(800)797-5937		(800)797-5937		(855)690-7798		(855)690-7798		(844)364-2119		(844)364-2119		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	016	0	1	04	01	H4909_016_0	7	1				08/03/2018	2019.01	08/03/2018 02:31:53 PM Eastern Daylight Time	08/06/2018 12:45:23 AM Eastern Daylight Time	08/01/2018 08:19:31 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Basic (PPO)	01	04		1			H4909	016	0	2019	Select Counties in Missouri		2	6852	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7798		(855)690-7798		(800)797-5937		(800)797-5937		(855)690-7798		(855)690-7798		(844)364-2119		(844)364-2119		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	804	0	1	04	01	H4909_804_0	2	1				06/19/2018	2019.01	06/19/2018 01:02:44 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	804	0	2019	Virginia		1	10642	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	805	0	1	04	01	H4909_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:03:18 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	805	0	2019	Virginia		1	1951065	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	806	0	1	04	01	H4909_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:03:29 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	806	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	810	0	2	04	01	H4909_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:03:46 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4909	810	0	2019	National		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	811	0	1	04	01	H4909_811_0	2	1				06/19/2018	2019.01	06/19/2018 01:04:12 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	811	0	2019	National		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(833)848-8730		(833)848-8730		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	812	0	1	04	01	H4909_812_0	2	1				06/19/2018	2019.01	06/19/2018 01:04:26 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	812	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	813	0	2	04	01	H4909_813_0	2	1				06/19/2018	2019.01	06/19/2018 01:05:11 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4909	813	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	814	0	2	04	01	H4909_814_0	2	1				06/19/2018	2019.01	06/19/2018 01:05:55 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4909	814	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	815	0	2	04	01	H4909_815_0	2	1				06/19/2018	2019.01	06/19/2018 01:06:18 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4909	815	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	816	0	1	04	01	H4909_816_0	2	1				06/19/2018	2019.01	06/19/2018 01:06:33 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	816	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	817	0	1	04	01	H4909_817_0	2	1				06/19/2018	2019.01	06/19/2018 01:06:48 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	817	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	818	0	1	04	01	H4909_818_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:00 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	818	0	2019	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4922	003	0	1	01	01	H4922_003_0	7	1	2	1		08/06/2018	2019.01	08/06/2018 10:27:35 AM Eastern Daylight Time	08/06/2018 10:32:50 AM Eastern Daylight Time	08/02/2018 06:00:42 PM Eastern Daylight Time			08/07/2018 12:36:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York FeelWell (HMO SNP)	01	01		1			H4922	003	0	2019	New York City Metro Area, Nassau, Westchester		2	5335	2			1	3		1		1	www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H4922	004	0	1	01	01	H4922_004_0	7	1		1		08/06/2018	2019.01	08/06/2018 10:28:38 AM Eastern Daylight Time	08/06/2018 10:31:04 AM Eastern Daylight Time	08/02/2018 06:03:32 PM Eastern Daylight Time			08/07/2018 12:36:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York CareWell (HMO SNP)	01	01		1			H4922	004	0	2019	New York City Metro Area, Long Island, Westchester		2	10675	2			1	1	1				www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H4922	008	0	1	01	01	H4922_008_0	9	1				07/18/2018	2019.01	07/18/2018 04:38:17 PM Eastern Daylight Time	08/06/2018 02:14:02 PM Eastern Daylight Time	08/02/2018 06:05:06 PM Eastern Daylight Time			08/07/2018 12:36:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York PlanWell (HMO)	01	01		1			H4922	008	0	2019	New York City Metro Area, Nassau, Westchester		2	2902	2			2						www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H4922	010	0	1	01	01	H4922_010_0	7	1	2	1		08/06/2018	2019.01	08/06/2018 10:30:09 AM Eastern Daylight Time	08/06/2018 10:39:46 AM Eastern Daylight Time	08/02/2018 06:07:46 PM Eastern Daylight Time			08/07/2018 12:36:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York Advantage Plus (HMO SNP)	01	01		1			H4922	010	0	2019	New York City Metro Area, Nassau, Westchester		2	1279	2			1	3		1		1	www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H4922	011	0	1	01	01	H4922_011_0	9	1				07/18/2018	2019.01	07/18/2018 04:38:57 PM Eastern Daylight Time	08/06/2018 10:42:12 AM Eastern Daylight Time	08/02/2018 06:08:52 PM Eastern Daylight Time			08/07/2018 12:36:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York LiveWell (HMO)	01	01		1			H4922	011	0	2019	New York City Metro Area, Nassau, Westchester		2	13012	2			2						www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H4931	001	0	1	01	01	H4931_001_0	8	1	2	1		08/03/2018	2019.01	08/03/2018 11:46:30 AM US Mountain Standard Time	08/06/2018 06:09:11 PM US Mountain Standard Time	08/06/2018 06:09:11 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	001	0	2019	Cochise, Gila, Graham, Greenlee, La Paz		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	006	0	1	01	01	H4931_006_0	8	1	2	1		08/03/2018	2019.01	08/03/2018 11:42:51 AM US Mountain Standard Time	08/06/2018 06:09:12 PM US Mountain Standard Time	08/06/2018 06:09:12 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	006	0	2019	Pima County		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	007	0	1	01	01	H4931_007_0	8	1	2	1		08/03/2018	2019.01	08/03/2018 11:45:22 AM US Mountain Standard Time	08/06/2018 06:09:12 PM US Mountain Standard Time	08/06/2018 06:09:12 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	007	0	2019	Pinal, Maricopa		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	008	0	1	01	01	H4931_008_0	8	1	2	1		08/03/2018	2019.01	08/03/2018 11:49:55 AM US Mountain Standard Time	08/06/2018 06:09:13 PM US Mountain Standard Time	08/06/2018 06:09:13 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	008	0	2019	Santa Cruz, Yuma		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	013	0	1	01	01	H4931_013_0	8	1	2	1		08/03/2018	2019.01	08/03/2018 11:52:19 AM US Mountain Standard Time	08/06/2018 06:09:13 PM US Mountain Standard Time	08/06/2018 06:09:14 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	013	0	2019	ALTCS: Cochise, Gila, Graham, Greenlee, La Paz		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	014	0	1	01	01	H4931_014_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 11:53:35 AM US Mountain Standard Time	08/06/2018 06:09:10 PM US Mountain Standard Time	08/06/2018 06:09:10 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	014	0	2019	ALTCS: Pima		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	015	0	1	01	01	H4931_015_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 11:53:35 AM US Mountain Standard Time	08/06/2018 06:09:10 PM US Mountain Standard Time	08/06/2018 06:09:10 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	015	0	2019	ALTCS: Maricopa, Pinal		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	016	0	1	01	01	H4931_016_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 11:53:35 AM US Mountain Standard Time	08/06/2018 06:09:11 PM US Mountain Standard Time	08/06/2018 06:09:11 PM US Mountain Standard Time			08/06/2018 06:14:28 PM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	University Care Advantage	https://www.universitycareadvantage.com/	Banner - University Care Advantage (HMO SNP)	01	01		1			H4931	016	0	2019	ALTCS: Santa Cruz, Yuma		2		2			1	3		2		2	https://www.universitycareadvantage.com/en/find-a-pharmacy	https://www.universitycareadvantage.com/plan-information/pharmacy-and-part-d-coverage	https://www.universitycareadvantage.com/en/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4999	001	0	1	20	08	H4999_001_0	1	1				05/29/2018	2019.01	05/29/2018 02:40:05 PM Eastern Daylight Time		05/29/2018 10:13:12 AM Eastern Daylight Time			05/29/2018 02:43:17 PM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	001	0	2019	Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla		2		2			2						www.lifenwpa.org	www.lifenwpa.org										(844)456-5433		(814)456-5433		(844)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433																
H4999	002	0	1	20	08	H4999_002_0	1	1				05/29/2018	2019.01	05/29/2018 02:40:32 PM Eastern Daylight Time		05/29/2018 10:12:48 AM Eastern Daylight Time			05/29/2018 02:43:17 PM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	002	0	2019	Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla		2		2			2						www.lifenwpa.org	www.lifenwpa.org										(844)456-5433		(814)456-5433		(844)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433																
H5007	001	0	1	20	08	H5007_001_0	1	1				05/23/2018	2019.01	05/23/2018 03:13:25 PM Pacific Daylight Time		05/22/2018 01:48:57 PM Pacific Daylight Time			05/23/2018 03:28:41 PM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	08	20		1			H5007	001	0	2019	Seattle - King County Washington		2		2			2						www.providence.org/longtermcare/elderplace	www.providence.org/longtermcare/elderplace										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325																
H5007	002	0	1	20	08	H5007_002_0	1	1				05/23/2018	2019.01	05/23/2018 03:14:19 PM Pacific Daylight Time		05/22/2018 01:49:38 PM Pacific Daylight Time			05/23/2018 03:28:41 PM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	08	20		1			H5007	002	0	2019	Seattle - King County Washington		2		2			2						www.providence.org/longtermcare/elderplace	www.providence.org/longtermcare/elderplace										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325																
H5008	001	0	1	01	01	H5008_001_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:57:11 PM Central Daylight Time	08/03/2018 10:45:30 AM Central Daylight Time	08/01/2018 06:04:00 PM Central Daylight Time			08/06/2018 12:20:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5008	001	0	2019	King, Kitsap, Pierce, and Snohomish Counties		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	002	0	1	01	01	H5008_002_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 12:49:15 PM Central Daylight Time	08/03/2018 10:45:56 AM Central Daylight Time	07/31/2018 07:17:10 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5008	002	0	2019	Select Counties in Washington		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4984		(866)944-4984		(888)834-3721		(888)834-3721		(866)944-4984		(866)944-4984		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	009	0	1	02	01	H5008_009_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:13:00 PM Central Daylight Time	08/03/2018 10:46:25 AM Central Daylight Time	07/31/2018 07:17:36 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS SNP)	01	02		1			H5008	009	0	2019	Select counties in New Mexico		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	010	0	1	01	01	H5008_010_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:13:13 PM Central Daylight Time	08/03/2018 10:46:54 AM Central Daylight Time	07/31/2018 07:18:08 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5008	010	0	2019	New Orleans Metro area		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)263-0627		(866)263-0627		(888)834-3721		(888)834-3721		(866)263-0627		(866)263-0627		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	011	0	1	01	01	H5008_011_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:15:32 PM Central Daylight Time	08/03/2018 10:47:22 AM Central Daylight Time	07/31/2018 07:18:34 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5008	011	0	2019	Select Counties in Mississippi		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)263-1164		(866)263-1164		(888)834-3721		(888)834-3721		(866)263-1164		(866)263-1164		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	012	0	1	01	01	H5008_012_0	4	1	2	1		05/30/2018	2019.01	05/30/2018 12:49:22 PM Central Daylight Time	08/03/2018 10:47:48 AM Central Daylight Time	07/31/2018 07:18:58 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5008	012	0	2019	Gila County		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5009	001	0	1	04	01	H5009_001_0	6	1				07/20/2018	2019.01	07/20/2018 02:11:59 PM Mountain Daylight Time	07/19/2018 07:04:43 PM Mountain Daylight Time				07/20/2018 03:58:30 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H5009	001	0	2019	Select Counties in Washington		2	9066	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5009	002	0	1	04	01	H5009_002_0	8	1				07/18/2018	2019.01	07/18/2018 06:48:29 PM Mountain Daylight Time	08/01/2018 11:32:23 PM Mountain Daylight Time	08/01/2018 11:32:53 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H5009	002	0	2019	Select Counties in Washington		2	190910	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5009	008	0	1	04	01	H5009_008_0	9	1				07/18/2018	2019.01	07/18/2018 06:57:03 PM Mountain Daylight Time	08/02/2018 12:09:39 AM Mountain Daylight Time	08/01/2018 11:57:10 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H5009	008	0	2019	Select Counties in Washington		2	12320	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5009	801	0	1	04	01	H5009_801_0	1	1				05/08/2018	2019.01	05/08/2018 10:17:31 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H5009	801	0	2019	Nationwide except territories		1	27810	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5009	802	0	1	04	01	H5009_802_0	1	1				05/18/2018	2019.01	05/18/2018 11:26:42 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H5009	802	0	2019	Nationwide except territories		1	8698	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5009	803	0	1	04	01	H5009_803_0	1	1				05/18/2018	2019.01	05/18/2018 11:23:35 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	01	04		1			H5009	803	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5009	804	0	1	04	01	H5009_804_0	1	1				05/18/2018	2019.01	05/18/2018 11:43:20 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	01	04		1			H5009	804	0	2019	Nationwide except Territories		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5010	001	0	1	04	01	H5010_001_0	6	1				07/18/2018	2019.01	07/18/2018 07:06:09 PM Mountain Daylight Time	07/19/2018 07:07:10 PM Mountain Daylight Time				07/20/2018 03:58:30 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage Basic (PPO)	01	04		1			H5010	001	0	2019	Spokane County		2	786	2			2						www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5010	002	0	1	04	01	H5010_002_0	8	1				07/18/2018	2019.01	07/18/2018 07:12:50 PM Mountain Daylight Time	08/01/2018 11:58:57 PM Mountain Daylight Time	08/01/2018 11:59:39 PM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Classic (PPO)	01	04		1			H5010	002	0	2019	Spokane County		2	8028	2			2						www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5010	004	0	1	04	01	H5010_004_0	9	1				07/18/2018	2019.01	07/18/2018 07:19:27 PM Mountain Daylight Time	08/02/2018 12:00:31 AM Mountain Daylight Time	08/02/2018 12:01:09 AM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Enhanced (PPO)	01	04		1			H5010	004	0	2019	Spokane County		2	2952	2			2						www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5037	001	0	1	20	08	H5037_001_0	2	1				05/21/2018	2019.01	05/21/2018 11:45:43 AM Eastern Daylight Time		05/21/2018 11:25:59 AM Eastern Daylight Time			05/21/2018 12:07:37 PM Eastern Daylight Time	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE - Dual (PACE)	08	20		1			H5037	001	0	2019	Lee, Scott, Wise Counties and Norton City		2		2			2						www.meoc.org	www.meoc.org										(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599										(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599																
H5037	002	0	1	20	08	H5037_002_0	2	1				05/21/2018	2019.01	05/21/2018 11:46:19 AM Eastern Daylight Time		05/21/2018 11:25:59 AM Eastern Daylight Time			05/21/2018 12:07:37 PM Eastern Daylight Time	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE  - Medicare only (PACE)	08	20		1			H5037	002	0	2019	Lee, Scott, Wise Counties and Norton City		2		2			2						www.meoc.org	www.meoc.org										(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599										(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599																
H5042	801	0	1	04	01	H5042_801_0	3	1				07/06/2018	2019.01	07/06/2018 11:16:08 AM Eastern Daylight Time					07/06/2018 11:16:20 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices		CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	801	0	2019	Greater Capital Region of New York State		1	840	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8a;8b2;8b3;11a;11b;	1	1a;1b;2;5;6;8a;8b1;8b2;8b3;14d;	1									
H5042	802	0	1	04	01	H5042_802_0	3	1				07/03/2018	2019.01	07/03/2018 12:55:47 PM Eastern Daylight Time					07/06/2018 11:16:20 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices		CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	802	0	2019	Greater Capital Region of New York State		1	39058	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;8b2;8b3;11a;11b;	1	1a;1b;2;5;8b1;8b2;8b3;14d;	1									
H5042	803	0	1	04	01	H5042_803_0	3	1				07/03/2018	2019.01	07/03/2018 12:55:40 PM Eastern Daylight Time					07/06/2018 11:16:20 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices		CDPHP Group Medicare (PPO)	01	04		1			H5042	803	0	2019	Greater Capital Region of New York State		1	5398	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;8b2;8b3;	1	1a;1b;2;5;8b1;8b2;8b3;	1									
H5050	001	0	1	01	01	H5050_001_0	4	1				06/29/2018	2019.01	06/29/2018 08:19:51 AM Pacific Daylight Time	07/13/2018 10:58:40 AM Pacific Daylight Time				07/23/2018 10:41:50 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Basic (HMO)	01	01		1			H5050	001	0	2019	Puget Sound Area and Counties: GY, TH, LE, SP		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5050	004	0	1	01	01	H5050_004_0	6	1				06/29/2018	2019.01	06/29/2018 08:19:36 AM Pacific Daylight Time	08/02/2018 04:32:26 PM Pacific Daylight Time	07/31/2018 03:25:34 PM Pacific Daylight Time			08/03/2018 01:06:29 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Optimal (HMO)	01	01		1			H5050	004	0	2019	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	009	0	1	01	01	H5050_009_0	6	1				08/02/2018	2019.01	08/02/2018 12:14:53 PM Pacific Daylight Time	08/02/2018 04:33:56 PM Pacific Daylight Time	07/31/2018 03:26:57 PM Pacific Daylight Time			08/03/2018 01:06:29 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Essential (HMO)	01	01		1			H5050	009	0	2019	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	013	0	1	01	01	H5050_013_0	6	1				08/02/2018	2019.01	08/02/2018 12:16:42 PM Pacific Daylight Time	08/02/2018 04:35:26 PM Pacific Daylight Time	07/31/2018 03:28:16 PM Pacific Daylight Time			08/03/2018 01:06:29 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Vital (HMO)	01	01		1			H5050	013	0	2019	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	017	0	1	01	01	H5050_017_0	5	1				08/02/2018	2019.01	08/02/2018 12:17:21 PM Pacific Daylight Time	08/02/2018 04:36:57 PM Pacific Daylight Time	07/31/2018 03:29:36 PM Pacific Daylight Time			08/03/2018 01:06:29 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Harbor (HMO)	01	01		1			H5050	017	0	2019	Counties: SK, SJ, IS, WM		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	019	0	1	01	01	H5050_019_0	6	1				08/02/2018	2019.01	08/02/2018 12:18:16 PM Pacific Daylight Time	08/02/2018 04:38:26 PM Pacific Daylight Time	07/31/2018 03:30:53 PM Pacific Daylight Time			08/03/2018 01:06:29 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Columbia (HMO)	01	01		1			H5050	019	0	2019	Spokane		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	021	0	1	01	01	H5050_021_0	5	1				08/02/2018	2019.01	08/02/2018 12:19:13 PM Pacific Daylight Time	08/02/2018 04:39:55 PM Pacific Daylight Time	07/31/2018 03:32:18 PM Pacific Daylight Time			08/03/2018 01:06:29 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Centennial (HMO)	01	01		1			H5050	021	0	2019	Spokane		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	022	0	1	01	01	H5050_022_0	5	1				08/02/2018	2019.01	08/02/2018 12:21:06 PM Pacific Daylight Time	08/02/2018 04:41:14 PM Pacific Daylight Time	07/31/2018 03:33:31 PM Pacific Daylight Time			08/03/2018 01:06:29 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Key (HMO)	01	01		1			H5050	022	0	2019	King, Pierce and Thurston counties		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	801	0	1	01	01	H5050_801_0	2	1				05/31/2018	2019.01	05/31/2018 08:07:16 AM Pacific Daylight Time					06/04/2018 01:35:59 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Group [AB] (HMO)	01	01		1			H5050	801	0	2019	Puget Sound Area and Counties: GY, TH, LE, SP		1	323314	2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)446-8882		(800)446-8882										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;9a1;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	1					2				
H5050	802	0	1	01	01	H5050_802_0	2	1				05/31/2018	2019.01	05/31/2018 08:07:52 AM Pacific Daylight Time					06/04/2018 01:35:59 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Group [ABD] (HMO)	01	01		1			H5050	802	0	2019	Puget Sound Area and Counties: GY, TH, LE, SP		1	41925	2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)630-4600		(800)446-8882		(800)446-8882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;9a1;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	1					2				
H5085	003	0	1	20	08	H5085_003_0	1	1				06/01/2018	2019.01	06/01/2018 02:10:07 PM Eastern Daylight Time		06/01/2018 02:18:45 PM Eastern Daylight Time			06/01/2018 02:20:13 PM Eastern Daylight Time	COMMUNITY PACE AT HOME, INC.	Community PACE at Home, Inc,	N/A	Community PACE at Home, Inc. - Dual Eligible (PACE)	08	20		1			H5085	003	0	2019	Lake, Newaygo, Oceana, Osceola, Mason, Mecosta		2		2			2						N/A	N/A												(231)689-6675				(231)689-6675												(231)689-6675				(231)689-6675																
H5085	004	0	1	20	08	H5085_004_0	1	1				06/01/2018	2019.01	06/01/2018 02:10:20 PM Eastern Daylight Time		06/01/2018 02:17:51 PM Eastern Daylight Time			06/01/2018 02:20:13 PM Eastern Daylight Time	COMMUNITY PACE AT HOME, INC.	Community PACE at Home, Inc,	N/A	Community PACE at Home, Inc - Medicare Only (PACE)	08	20		1			H5085	004	0	2019	Lake, Newaygo, Oceana, Osceola, Mason, Mecosta		2		2			2						N/A	N/A												(231)689-6675				(231)689-6675												(231)689-6675				(231)689-6675																
H5087	001	0	1	01	01	H5087_001_0	5	1	2	1		07/12/2018	2019.01	07/12/2018 05:10:37 PM Eastern Daylight Time	08/06/2018 05:44:07 PM Eastern Daylight Time	08/01/2018 02:41:00 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	Easy Choice Freedom Plan (HMO SNP)	01	01		1			H5087	001	0	2019	Los Angeles County		2	54804	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	002	0	1	01	01	H5087_002_0	5	1				07/12/2018	2019.01	07/12/2018 05:12:49 PM Eastern Daylight Time	08/06/2018 05:44:50 PM Eastern Daylight Time	08/01/2018 02:41:21 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	Easy Choice Plus Plan (HMO)	01	01		1			H5087	002	0	2019	Select Counties in CA		2	53412	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	005	0	1	01	01	H5087_005_0	4	1				08/03/2018	2019.01	08/03/2018 02:38:54 PM Eastern Daylight Time	08/06/2018 05:45:31 PM Eastern Daylight Time	08/01/2018 02:41:42 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	Easy Choice Best Plan (HMO)	01	01		1			H5087	005	0	2019	Los Angeles, Orange Counties		2	115347	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	016	0	1	01	01	H5087_016_0	5	1				08/03/2018	2019.01	08/03/2018 02:38:08 PM Eastern Daylight Time	08/06/2018 05:46:13 PM Eastern Daylight Time	08/01/2018 02:42:05 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	Easy Choice Best Plan (HMO)	01	01		1			H5087	016	0	2019	Riverside, San Bernardino Counties		2	9204	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	017	0	1	01	01	H5087_017_0	5	1				07/12/2018	2019.01	07/12/2018 05:16:53 PM Eastern Daylight Time	08/06/2018 05:46:57 PM Eastern Daylight Time	08/01/2018 02:42:26 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	Easy Choice Plus Plan (HMO)	01	01		1			H5087	017	0	2019	Los Angeles County		2	158237	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	023	0	1	01	01	H5087_023_0	6	1				07/12/2018	2019.01	07/12/2018 05:18:50 PM Eastern Daylight Time	08/06/2018 05:47:41 PM Eastern Daylight Time	08/01/2018 02:42:47 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	Easy Choice Rx (HMO)	01	01		1			H5087	023	0	2019	Select Counties in CA		2	6194	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5106	013	0	1	04	01	H5106_013_0	7	1				05/18/2018	2019.01	05/18/2018 01:58:16 PM Eastern Daylight Time	08/01/2018 08:59:13 PM Eastern Daylight Time	08/01/2018 11:05:54 AM Eastern Daylight Time			08/03/2018 09:07:28 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO Standard (PPO)	01	04		1			H5106	013	0	2019	West Virginia Region 1 counties		2		2			2						www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5106	806	0	1	04	01	H5106_806_0	6	1				05/03/2018	2019.01	05/03/2018 10:26:25 AM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MAPD WV NON-CALENDAR (PPO)	01	04		1			H5106	806	0	2019	ALL WV COUNTIES		1	0	2			2						www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H5106	807	0	1	04	01	H5106_807_0	6	1				05/03/2018	2019.01	05/03/2018 10:22:45 AM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MA WV (PPO)	01	04		1			H5106	807	0	2019	ALL WV COUNTIES		1	276	2			2						www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H5106	808	0	1	04	01	H5106_808_0	6	1				05/03/2018	2019.01	05/03/2018 10:25:04 AM Eastern Daylight Time					06/01/2018 03:35:12 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MAPD WV CALENDAR (PPO)	01	04		1			H5106	808	0	2019	ALL WV COUNTIES		1	12792	2			2						www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H5117	001	0	1	01	01	H5117_001_0	8	1				08/01/2018	2019.01	08/01/2018 10:03:45 AM Eastern Daylight Time	08/03/2018 07:22:25 PM Eastern Daylight Time	08/03/2018 07:51:46 PM Eastern Daylight Time			08/03/2018 08:34:16 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Allwell	allwell.louisianahealthconnect.com	Allwell Medicare (HMO)	01	01		1			H5117	001	0	2019	Acn,EBat Ru,WBat Ru, Liv,Tag,Iber,PCoup,St Jam,Wah		2		2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	002	0	1	01	01	H5117_002_0	9	1				08/01/2018	2019.01	08/01/2018 10:05:13 AM Eastern Daylight Time	08/03/2018 07:22:25 PM Eastern Daylight Time	08/03/2018 07:51:46 PM Eastern Daylight Time			08/03/2018 08:34:16 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Allwell	allwell.louisianahealthconnect.com	Allwell Medicare (HMO)	01	01		1			H5117	002	0	2019	St. Tammany		2		2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	003	0	1	01	01	H5117_003_0	8	1				08/01/2018	2019.01	08/01/2018 10:06:27 AM Eastern Daylight Time	08/03/2018 07:22:26 PM Eastern Daylight Time	08/03/2018 07:51:46 PM Eastern Daylight Time			08/03/2018 08:34:16 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Allwell	allwell.louisianahealthconnect.com	Allwell Medicare (HMO)	01	01		1			H5117	003	0	2019	Acadia, Lafayette, St. Martin, St. Landry		2		2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	801	0	1	01	01	H5117_801_0	4	1				05/29/2018	2019.01	05/29/2018 04:39:33 PM Pacific Daylight Time					06/03/2018 10:10:12 PM Pacific Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	801	0	2019	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5117	802	0	1	01	01	H5117_802_0	4	1				05/29/2018	2019.01	05/29/2018 05:28:02 PM Pacific Daylight Time					06/03/2018 10:10:12 PM Pacific Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	802	0	2019	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5117	803	0	1	01	01	H5117_803_0	4	1				05/29/2018	2019.01	05/29/2018 04:39:43 PM Pacific Daylight Time					06/03/2018 10:10:12 PM Pacific Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	803	0	2019	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5124	001	0	1	20	08	H5124_001_0	1	1				05/22/2018	2019.01	05/22/2018 09:18:23 AM US Eastern Daylight Time		05/22/2018 09:05:56 AM US Eastern Daylight Time			05/22/2018 09:22:32 AM US Eastern Daylight Time	FRANCISCAN ACO, INC.	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	001	0	2019	Central and Northern Indiana		2		2			2						carekinesis.org	franciscanalliance.org										(844)817-7223		(317)528-7223		(844)817-7223		(317)528-7223										(800)743-3333		(317)528-6395		(800)743-3333		(317)528-6395																
H5124	002	0	1	20	08	H5124_002_0	1	1				05/22/2018	2019.01	05/22/2018 09:18:55 AM US Eastern Daylight Time		05/22/2018 09:05:43 AM US Eastern Daylight Time			05/22/2018 09:22:32 AM US Eastern Daylight Time	FRANCISCAN ACO, INC.	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	002	0	2019	Central and Northern Indiana		2		2			2						carekinesis.org	franciscanalliance.org										(844)817-7223		(317)528-7223		(844)817-7223		(317)528-7223										(800)743-3333		(317)528-6395		(800)743-3333		(317)528-6395																
H5141	001	0	1	04	01	H5141_001_0	18	1				08/06/2018	2019.01	08/06/2018 11:33:53 PM Pacific Daylight Time	08/07/2018 09:11:02 PM Pacific Daylight Time	08/01/2018 07:25:50 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	001	0	2019	Hudson County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	004	0	1	04	01	H5141_004_0	16	1				08/07/2018	2019.01	08/07/2018 03:30:50 PM Pacific Daylight Time	08/07/2018 09:13:22 PM Pacific Daylight Time	08/01/2018 07:25:50 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	004	0	2019	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	007	0	1	04	01	H5141_007_0	17	1				08/09/2018	2019.01	08/09/2018 09:58:54 AM Pacific Daylight Time	08/07/2018 09:15:02 PM Pacific Daylight Time	08/01/2018 07:25:50 PM Pacific Daylight Time			08/09/2018 10:06:10 AM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	007	0	2019	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	025	0	1	04	01	H5141_025_0	14	1				08/09/2018	2019.01	08/09/2018 10:00:59 AM Pacific Daylight Time	08/07/2018 09:19:42 PM Pacific Daylight Time	08/01/2018 07:25:50 PM Pacific Daylight Time			08/09/2018 10:06:10 AM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	025	0	2019	Bexar County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(210)526-3962		(888)466-5044		(210)526-3962		(888)657-1207		(210)526-3962		(888)466-5044		(210)526-3962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	026	0	1	04	01	H5141_026_0	15	1				08/09/2018	2019.01	08/09/2018 10:01:57 AM Pacific Daylight Time	08/07/2018 09:19:40 PM Pacific Daylight Time	08/01/2018 07:25:50 PM Pacific Daylight Time			08/09/2018 10:06:10 AM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	026	0	2019	Chatham County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(912)805-3271		(888)466-5044		(912)805-3269		(888)657-1207		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	032	0	1	04	01	H5141_032_0	17	1				07/26/2018	2019.01	07/26/2018 09:48:47 AM Pacific Daylight Time	08/07/2018 09:19:38 PM Pacific Daylight Time	08/01/2018 07:25:54 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Premier (PPO)	01	04		1			H5141	032	0	2019	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	033	0	1	04	01	H5141_033_0	11	1				08/06/2018	2019.01	08/06/2018 11:15:23 PM Pacific Daylight Time	08/07/2018 09:21:50 PM Pacific Daylight Time	08/01/2018 07:25:50 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	033	0	2019	Davidson, Rutherford & Williamson Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	034	0	1	04	01	H5141_034_0	15	1				08/06/2018	2019.01	08/06/2018 11:18:13 PM Pacific Daylight Time	08/07/2018 09:22:00 PM Pacific Daylight Time	08/01/2018 07:25:54 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	034	0	2019	Davidson, Rutherford & Williamson Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	035	0	1	04	01	H5141_035_0	14	1				08/06/2018	2019.01	08/06/2018 11:21:03 PM Pacific Daylight Time	08/07/2018 09:23:48 PM Pacific Daylight Time	08/01/2018 07:25:54 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	035	0	2019	El Paso County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	036	0	1	04	01	H5141_036_0	14	1				08/07/2018	2019.01	08/07/2018 03:30:04 PM Pacific Daylight Time	08/07/2018 09:25:28 PM Pacific Daylight Time	08/01/2018 07:26:02 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	036	0	2019	Charleston County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	037	0	1	04	01	H5141_037_0	13	1				08/07/2018	2019.01	08/07/2018 04:58:39 PM Pacific Daylight Time	08/07/2018 09:25:30 PM Pacific Daylight Time	08/01/2018 07:26:04 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	037	0	2019	Charleston County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	038	0	1	04	01	H5141_038_0	13	1				08/07/2018	2019.01	08/07/2018 03:32:51 PM Pacific Daylight Time	08/07/2018 09:28:28 PM Pacific Daylight Time	08/01/2018 07:26:04 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	038	0	2019	Bucks and Philadelphia Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	039	0	1	04	01	H5141_039_0	15	1				08/06/2018	2019.01	08/06/2018 11:22:35 PM Pacific Daylight Time	08/07/2018 09:28:28 PM Pacific Daylight Time	08/01/2018 07:26:04 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	039	0	2019	Bucks and Philadelphia Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	040	0	1	04	01	H5141_040_0	16	1				08/07/2018	2019.01	08/07/2018 03:33:43 PM Pacific Daylight Time	08/07/2018 09:28:26 PM Pacific Daylight Time	08/01/2018 07:26:04 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	040	0	2019	Pima County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	041	0	1	04	01	H5141_041_0	15	1				08/07/2018	2019.01	08/07/2018 03:36:28 PM Pacific Daylight Time	08/07/2018 09:31:24 PM Pacific Daylight Time	08/01/2018 07:26:04 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	041	0	2019	Southern NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	042	0	1	04	01	H5141_042_0	13	1				08/06/2018	2019.01	08/06/2018 11:27:34 PM Pacific Daylight Time	08/07/2018 09:35:14 PM Pacific Daylight Time	08/01/2018 07:26:06 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	042	0	2019	Southern NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	043	0	1	04	01	H5141_043_0	12	1				08/07/2018	2019.01	08/07/2018 11:37:07 AM Pacific Daylight Time	08/07/2018 09:35:16 PM Pacific Daylight Time	08/01/2018 07:26:04 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Plus (PPO)	01	04		1			H5141	043	0	2019	Chatham County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5167	001	0	1	20	08	H5167_001_0	1	1				05/23/2018	2019.01	05/23/2018 11:11:32 AM Mountain Daylight Time		05/23/2018 11:17:56 AM Mountain Daylight Time			05/23/2018 12:38:57 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	001	0	2019	Colorado Springs Metro Area		2		2			2						www.rmhcare.org	www.rmhcare.org										(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300									(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300															
H5167	002	0	1	20	08	H5167_002_0	2	1				05/23/2018	2019.01	05/23/2018 11:11:53 AM Mountain Daylight Time		05/29/2018 11:50:21 AM Mountain Daylight Time			05/29/2018 11:52:04 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	002	0	2019	Colorado Springs Metro Area		2		2			2						www.rmhcare.org	www.rmhcare.org										(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300									(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300															
H5172	002	0	1	48	05	H5172_002_0	3	1				08/10/2018	2019.01	08/10/2018 11:37:43 AM Pacific Daylight Time					08/10/2018 11:39:16 AM Pacific Daylight Time	COMMUNITY HEALTH GROUP	Community Health Group	www.chgsd.com	CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H5172	002	0	2019	San Diego, California		2	78886	2			2						http://www.chgsd.com/	www.chgsd.com	www.chgsd.com	(888)244-4430		(619)422-0422		(888)244-4430		(619)422-0422		(888)244-4430		(619)422-0422		(888)244-4430		(619)422-0422		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584																
H5190	001	0	1	01	01	H5190_001_0	6	1	2	1		08/03/2018	2019.01	08/03/2018 01:52:38 PM Eastern Daylight Time	08/03/2018 07:22:26 PM Eastern Daylight Time	08/03/2018 07:51:46 PM Eastern Daylight Time			08/03/2018 09:07:09 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5190	001	0	2019	9 Counties in Central and North Florida		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	002	0	1	01	01	H5190_002_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 01:52:57 PM Eastern Daylight Time	08/06/2018 09:09:50 PM Eastern Daylight Time	08/06/2018 09:08:53 PM Eastern Daylight Time			08/06/2018 09:35:34 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5190	002	0	2019	9 Counties in Central and North Florida		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	003	0	1	01	01	H5190_003_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 08:39:46 PM Eastern Daylight Time	08/03/2018 07:22:26 PM Eastern Daylight Time	08/03/2018 07:51:46 PM Eastern Daylight Time			08/03/2018 09:07:09 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5190	003	0	2019	Broward Counties		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	004	0	1	01	01	H5190_004_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 08:39:52 PM Eastern Daylight Time	08/03/2018 07:22:26 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:07:09 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5190	004	0	2019	Miami-Dade County		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5199	001	0	1	04	01	H5199_001_0	4	1				08/03/2018	2019.01	08/03/2018 01:35:47 PM Eastern Daylight Time	08/06/2018 05:48:25 PM Eastern Daylight Time	08/01/2018 02:43:08 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	001	0	2019	Selected FL Counties		2	634	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	002	0	1	04	01	H5199_002_0	4	1				08/03/2018	2019.01	08/03/2018 01:35:16 PM Eastern Daylight Time	08/06/2018 05:49:07 PM Eastern Daylight Time	08/01/2018 02:43:29 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	002	0	2019	Selected FL Counties		2	525	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	003	0	1	04	01	H5199_003_0	4	1				08/03/2018	2019.01	08/03/2018 01:34:36 PM Eastern Daylight Time	08/06/2018 05:49:48 PM Eastern Daylight Time	08/01/2018 02:43:50 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	003	0	2019	Selected FL Counties		2	856	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	004	0	1	04	01	H5199_004_0	4	1				08/03/2018	2019.01	08/03/2018 01:33:56 PM Eastern Daylight Time	08/06/2018 05:50:31 PM Eastern Daylight Time	08/01/2018 02:44:11 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	004	0	2019	Selected FL Counties		2	730	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	005	0	1	04	01	H5199_005_0	4	1				08/03/2018	2019.01	08/03/2018 01:33:23 PM Eastern Daylight Time	08/06/2018 05:51:14 PM Eastern Daylight Time	08/01/2018 02:44:32 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	005	0	2019	Selected FL Counties		2	1516	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	006	0	1	04	01	H5199_006_0	4	1				08/03/2018	2019.01	08/03/2018 01:32:39 PM Eastern Daylight Time	08/06/2018 05:51:56 PM Eastern Daylight Time	08/01/2018 02:44:53 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	01	04		1			H5199	006	0	2019	Selected FL Counties		2	2274	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	007	0	1	04	01	H5199_007_0	4	1				08/03/2018	2019.01	08/03/2018 01:32:01 PM Eastern Daylight Time	08/06/2018 05:52:38 PM Eastern Daylight Time	08/01/2018 02:45:14 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	007	0	2019	Selected FL Counties		2	569	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	008	0	1	04	01	H5199_008_0	4	1				08/03/2018	2019.01	08/03/2018 01:30:57 PM Eastern Daylight Time	08/06/2018 05:53:22 PM Eastern Daylight Time	08/01/2018 02:45:35 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	008	0	2019	Selected FL Counties		2	948	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	009	0	1	04	01	H5199_009_0	4	1				08/03/2018	2019.01	08/03/2018 01:30:02 PM Eastern Daylight Time	08/06/2018 05:54:04 PM Eastern Daylight Time	08/01/2018 02:45:56 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	009	0	2019	Selected FL Counties		2	1137	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	010	0	1	04	01	H5199_010_0	4	1				08/03/2018	2019.01	08/03/2018 01:29:19 PM Eastern Daylight Time	08/06/2018 05:54:45 PM Eastern Daylight Time	08/01/2018 02:46:17 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	01	04		1			H5199	010	0	2019	Selected FL Counties		2	1137	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	011	0	1	04	01	H5199_011_0	4	1				08/03/2018	2019.01	08/03/2018 01:28:32 PM Eastern Daylight Time	08/06/2018 05:55:27 PM Eastern Daylight Time	08/01/2018 02:46:37 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	011	0	2019	Selected FL Counties		2	1516	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	012	0	1	04	01	H5199_012_0	4	1				08/03/2018	2019.01	08/03/2018 01:27:55 PM Eastern Daylight Time	08/06/2018 05:56:09 PM Eastern Daylight Time	08/01/2018 02:46:58 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H5199	012	0	2019	Selected FL Counties		2	1895	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5209	002	0	1	01	01	H5209_002_0	5	1	2	1		06/01/2018	2019.01	06/01/2018 02:44:51 PM Central Daylight Time	08/06/2018 11:20:42 AM Central Daylight Time	08/06/2018 11:20:40 AM Central Daylight Time			08/06/2018 11:25:34 AM Central Daylight Time	CARE WISCONSIN HEALTH PLAN, INC.	Care Wisconsin Health Plan, Inc.	www.carewisc.org	Care Wisconsin Partnership Plan (HMO SNP)	01	01		1			H5209	002	0	2019	Southcentral and Eastern Wisconsin		2		2			1	3		1		1	www.carewisc.org	www.carewisc.org	www.carewisc.org	(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;16b;17b;	2		1					1				
H5209	004	0	1	01	01	H5209_004_0	6	1	2	1		06/04/2018	2019.01	06/04/2018 07:32:03 PM Central Daylight Time	08/06/2018 11:21:14 AM Central Daylight Time	08/06/2018 11:21:12 AM Central Daylight Time			08/06/2018 11:25:34 AM Central Daylight Time	CARE WISCONSIN HEALTH PLAN, INC.	Care Wisconsin Health Plan, Inc.	www.carewisc.org	Care Wisconsin Medicare Dual Advantage Plan (HMO SNP)	01	01		1			H5209	004	0	2019	Southern, Central and Northeastern Wisconsin		2		2			1	3		1		1	www.carewisc.org	www.carewisc.org	www.carewisc.org	(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2	2			
H5211	001	0	1	02	01	H5211_001_0	5	1				07/06/2018	2019.01	07/06/2018 08:54:15 AM Central Daylight Time	06/02/2018 06:24:44 AM Central Daylight Time				07/06/2018 10:42:01 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Spirit (HMO-POS)	01	02		1			H5211	001	0	2019	Central, Northern, Western and South Central WI		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5211	002	0	1	02	01	H5211_002_0	6	1				07/06/2018	2019.01	07/06/2018 08:54:41 AM Central Daylight Time	08/06/2018 08:10:29 AM Central Daylight Time	08/06/2018 08:10:33 AM Central Daylight Time			08/06/2018 10:13:19 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Essence Rx (HMO-POS)	01	02		1			H5211	002	0	2019	Central, Northern, Western WI		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	003	0	1	02	01	H5211_003_0	5	1				07/06/2018	2019.01	07/06/2018 08:55:10 AM Central Daylight Time	06/02/2018 06:24:57 AM Central Daylight Time				07/06/2018 10:42:01 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Essence (HMO-POS)	01	02		1			H5211	003	0	2019	Central, Northern, Western  WI		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5211	004	0	1	02	01	H5211_004_0	7	1				07/06/2018	2019.01	07/06/2018 08:55:40 AM Central Daylight Time	08/06/2018 08:10:37 AM Central Daylight Time	08/06/2018 08:10:43 AM Central Daylight Time			08/06/2018 10:13:19 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Spirit Rx (HMO-POS)	01	02		1			H5211	004	0	2019	Central, Northern, Western and South Central WI		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	007	0	1	02	01	H5211_007_0	7	1				08/06/2018	2019.01	08/06/2018 09:50:16 AM Central Daylight Time	08/06/2018 08:10:48 AM Central Daylight Time	08/06/2018 08:10:51 AM Central Daylight Time			08/06/2018 09:59:09 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Assurance Rx (HMO-POS)	01	02		1			H5211	007	0	2019	Southern Wisconsin		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	008	0	1	02	01	H5211_008_0	6	1				08/06/2018	2019.01	08/06/2018 09:51:05 AM Central Daylight Time	08/06/2018 08:10:56 AM Central Daylight Time	08/06/2018 08:11:00 AM Central Daylight Time			08/06/2018 09:59:09 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Surety Rx (HMO-POS)	01	02		1			H5211	008	0	2019	Eastern Wisconsin		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/providersmedicare	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	009	0	1	02	01	H5211_009_0	6	1				07/06/2018	2019.01	07/06/2018 08:56:48 AM Central Daylight Time	08/06/2018 08:11:10 AM Central Daylight Time	08/06/2018 08:11:14 AM Central Daylight Time			08/06/2018 10:13:19 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Promise Rx (HMO-POS)	01	02		1			H5211	009	0	2019	Eastern Wisconsin		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/providersmedicare	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	010	0	1	01	01	H5211_010_0	6	1	2	1		07/06/2018	2019.01	07/06/2018 08:59:12 AM Central Daylight Time	08/06/2018 08:11:22 AM Central Daylight Time	08/06/2018 08:11:27 AM Central Daylight Time			08/06/2018 03:20:58 PM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Ally Rx (HMO SNP)	01	01		1			H5211	010	0	2019	Central Wisconsin		2		2			1	3		1		1	www.securityhealth.org/allypharmacies	www.securityhealth.org/allyformulary	www.securityhealth.org/allyproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	012	0	1	02	01	H5211_012_0	6	1				08/06/2018	2019.01	08/06/2018 09:51:32 AM Central Daylight Time	08/06/2018 08:11:34 AM Central Daylight Time	08/06/2018 08:11:37 AM Central Daylight Time			08/06/2018 09:59:09 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Esteem Rx (HMO-POS)	01	02		1			H5211	012	0	2019	Central, Northern, Western WI		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5212	001	0	1	20	08	H5212_001_0	1	1				04/24/2018	2019.01	04/24/2018 12:14:00 PM Central Daylight Time		05/22/2018 11:28:02 AM Central Daylight Time			05/22/2018 11:32:14 AM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	001	0	2019	Milwaukee County, Waukesha County, Racine County		2	5636	2			2						www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org									(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000										(711)-		(711)-		(711)-		(711)-																
H5212	002	0	1	20	08	H5212_002_0	1	1				04/24/2018	2019.01	04/24/2018 12:13:46 PM Central Daylight Time		05/22/2018 11:29:49 AM Central Daylight Time			05/22/2018 11:32:14 AM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	002	0	2019	Milwaukee County, Waukesha County, Racine County		2	10	2			2						www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org									(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000										(711)-		(711)-		(711)-		(711)-																
H5213	001	0	1	20	08	H5213_001_0	2	1				05/23/2018	2019.01	05/23/2018 02:19:37 PM Mountain Daylight Time		05/23/2018 02:04:45 PM Mountain Daylight Time			05/23/2018 02:44:58 PM Mountain Daylight Time	TOTAL COMMUNITY CARE, L.L.C.	InnovAge New Mexico PACE	www.MyInnovAge.com	Total Community Care (PACE)	08	20		1			H5213	001	0	2019	Albuquerque Metro Area		2		2			2						www.pharmerica.com	www.TotalCommunityCare.org										(844)326-2973		(844)326-2973		(844)326-2973		(844)326-2973										(855)487-6768		(855)487-6768		(855)487-6768		(855)487-6768																
H5213	002	0	1	20	08	H5213_002_0	2	1				05/23/2018	2019.01	05/23/2018 02:19:50 PM Mountain Daylight Time		05/23/2018 02:04:58 PM Mountain Daylight Time			05/23/2018 02:44:58 PM Mountain Daylight Time	TOTAL COMMUNITY CARE, L.L.C.	InnovAge New Mexico PACE	www.myinnovage.com	Total Community Care (PACE)	08	20		1			H5213	002	0	2019	Albuquerque Metro Area		2		2			2						www.pharmerica.com	www.TotalCommunityCare.org										(844)326-2973		(505)924-2650		(505)924-2608		(505)924-2608										(844)326-2973		(844)326-2973		(505)924-2608		(505)924-2608																
H5215	001	0	1	04	01	H5215_001_0	8	1				07/05/2018	2019.01	07/05/2018 09:03:55 AM Central Daylight Time	07/16/2018 09:41:23 AM Central Daylight Time				07/18/2018 09:25:53 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus (PPO)	01	04		1			H5215	001	0	2019	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										2					2						2			
H5215	002	0	1	04	01	H5215_002_0	10	1				07/05/2018	2019.01	07/05/2018 09:04:44 AM Central Daylight Time	07/31/2018 04:24:06 PM Central Daylight Time	08/03/2018 09:59:28 AM Central Daylight Time			08/03/2018 10:41:40 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus Pharmacy (PPO)	01	04		1			H5215	002	0	2019	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	005	0	1	04	01	H5215_005_0	9	1				07/05/2018	2019.01	07/05/2018 09:06:12 AM Central Daylight Time	07/31/2018 04:25:08 PM Central Daylight Time	08/03/2018 09:59:30 AM Central Daylight Time			08/03/2018 10:41:40 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier Pharmacy (PPO)	01	04		1			H5215	005	0	2019	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	006	0	1	04	01	H5215_006_0	7	1				07/05/2018	2019.01	07/05/2018 09:11:44 AM Central Daylight Time	07/16/2018 09:43:57 AM Central Daylight Time				07/18/2018 09:25:53 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier (PPO)	01	04		1			H5215	006	0	2019	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										2					2						2			
H5215	007	0	1	04	01	H5215_007_0	10	1	2	1		08/06/2018	2019.01	08/06/2018 12:19:26 PM Central Daylight Time	08/01/2018 11:36:31 AM Central Daylight Time	08/03/2018 09:59:32 AM Central Daylight Time			08/06/2018 12:50:27 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	NetworkCares (PPO SNP)	01	04		1			H5215	007	0	2019	East Central Wisconsin		2		2			1	3		2		2	www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	008	0	1	04	01	H5215_008_0	9	1				07/05/2018	2019.01	07/05/2018 09:16:54 AM Central Daylight Time	07/31/2018 04:27:00 PM Central Daylight Time	08/03/2018 09:59:34 AM Central Daylight Time			08/03/2018 10:41:40 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumSelect (PPO)	01	04		1			H5215	008	0	2019	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	009	0	1	04	01	H5215_009_0	9	1				07/05/2018	2019.01	07/05/2018 09:17:07 AM Central Daylight Time	07/31/2018 04:27:55 PM Central Daylight Time	08/03/2018 09:59:36 AM Central Daylight Time			08/03/2018 10:41:40 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network Health Medicare Go (PPO)	01	04		1			H5215	009	0	2019	Southeast Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	010	0	1	04	01	H5215_010_0	9	1				07/05/2018	2019.01	07/05/2018 09:17:47 AM Central Daylight Time	07/31/2018 04:28:49 PM Central Daylight Time	08/03/2018 09:59:39 AM Central Daylight Time			08/03/2018 10:41:40 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network Health Medicare Anywhere (PPO)	01	04		1			H5215	010	0	2019	Southeast Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	011	0	1	04	01	H5215_011_0	9	1				07/05/2018	2019.01	07/05/2018 09:18:19 AM Central Daylight Time	07/31/2018 04:29:48 PM Central Daylight Time	08/03/2018 09:59:41 AM Central Daylight Time			08/03/2018 10:41:40 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumChoice (PPO)	01	04		1			H5215	011	0	2019	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	806	0	1	04	01	H5215_806_0	5	1				04/13/2018	2019.01	04/13/2018 11:40:37 AM Central Daylight Time					06/04/2018 01:50:02 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus Pharmacy EGP (PPO)	01	04		1			H5215	806	0	2019	East Central WI		1	3600	2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;12;15;16b;	2		1									
H5215	807	0	1	04	01	H5215_807_0	5	1				04/13/2018	2019.01	04/13/2018 11:40:44 AM Central Daylight Time					06/04/2018 01:50:02 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier EGP (PPO)	01	04		1			H5215	807	0	2019	East Central WI		1	3600	2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;12;15;16b;	2		1									
H5215	808	0	1	04	01	H5215_808_0	5	1				04/13/2018	2019.01	04/13/2018 11:41:00 AM Central Daylight Time					06/04/2018 01:50:02 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier Pharmacy EGP (PPO)	01	04		1			H5215	808	0	2019	East Central WI		1	3600	2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;12;15;16b;	2		1									
H5216	001	0	1	04	01	H5216_001_0	5	1				07/05/2018	2019.01	07/05/2018 12:26:03 PM Eastern Daylight Time	07/18/2018 03:05:08 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-001 (PPO)	01	04		1			H5216	001	0	2019	Select Counties in Eastern Wisconsin		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	006	0	1	04	01	H5216_006_0	5	1				07/05/2018	2019.01	07/05/2018 12:55:05 PM Eastern Daylight Time	07/18/2018 02:54:57 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-006 (PPO)	01	04		1			H5216	006	0	2019	Madison area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	009	0	1	04	01	H5216_009_0	4	1				07/11/2018	2019.01	07/11/2018 02:23:40 PM Eastern Daylight Time	06/01/2018 12:56:58 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-009 (PPO)	01	04		1			H5216	009	0	2019	Select Counties in Western Michigan		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	011	0	1	04	01	H5216_011_0	4	1				07/11/2018	2019.01	07/11/2018 02:24:20 PM Eastern Daylight Time	08/03/2018 01:39:17 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-011 (PPO)	01	04		1			H5216	011	0	2019	Oakland, Macomb, and Wayne counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	013	0	1	04	01	H5216_013_0	5	1				07/05/2018	2019.01	07/05/2018 01:11:46 PM Eastern Daylight Time	08/03/2018 06:32:53 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-013 (PPO)	01	04		1			H5216	013	0	2019	Select Counties in Illinois		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	014	0	1	04	01	H5216_014_0	5	1				07/05/2018	2019.01	07/05/2018 01:20:30 PM Eastern Daylight Time	07/18/2018 03:03:41 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-014 (PPO)	01	04		1			H5216	014	0	2019	Select Counties in Iowa		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	015	1	1	04	01	H5216_015_1	4	1				07/02/2018	2019.01	07/02/2018 12:50:41 PM Eastern Daylight Time	07/17/2018 10:18:56 AM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:38:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-015 (PPO)	01	04		1			H5216	015	1	2019	Greater North Carolina Area	Western North Carolina	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	015	2	1	04	01	H5216_015_2	4	1				07/02/2018	2019.01	07/02/2018 12:51:02 PM Eastern Daylight Time	07/17/2018 10:18:27 AM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:38:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-015 (PPO)	01	04		1			H5216	015	2	2019	Greater North Carolina Area	Central North Carolina	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	017	0	1	04	01	H5216_017_0	4	1				07/03/2018	2019.01	07/03/2018 11:08:36 AM Eastern Daylight Time	07/17/2018 10:20:57 AM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:38:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-017 (PPO)	01	04		1			H5216	017	0	2019	Greensboro		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	018	0	1	04	01	H5216_018_0	3	1				07/06/2018	2019.01	07/06/2018 04:20:47 PM Eastern Daylight Time	08/03/2018 03:23:23 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-018 (PPO)	01	04		1			H5216	018	0	2019	Louisville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	019	0	1	04	01	H5216_019_0	3	1				07/05/2018	2019.01	07/05/2018 03:19:55 PM Eastern Daylight Time	06/01/2018 01:36:48 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-019 (PPO)	01	04		1			H5216	019	0	2019	Lexington Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	020	0	1	04	01	H5216_020_0	3	1				07/05/2018	2019.01	07/05/2018 02:33:01 PM Eastern Daylight Time	06/01/2018 01:30:45 PM Eastern Daylight Time	08/03/2018 09:21:06 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-020 (PPO)	01	04		1			H5216	020	0	2019	Barren, Metcalfe and Warren counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	021	0	1	04	01	H5216_021_0	3	1				07/05/2018	2019.01	07/05/2018 02:51:04 PM Eastern Daylight Time	06/01/2018 01:28:49 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-021 (PPO)	01	04		1			H5216	021	0	2019	Charleston-Huntington Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	022	0	1	04	01	H5216_022_0	3	1				07/05/2018	2019.01	07/05/2018 02:51:24 PM Eastern Daylight Time	06/01/2018 01:31:13 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-022 (PPO)	01	04		1			H5216	022	0	2019	Martinsburg Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	023	0	1	04	01	H5216_023_0	3	1				07/05/2018	2019.01	07/05/2018 02:01:01 PM Eastern Daylight Time	06/01/2018 12:57:35 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-023 (PPO)	01	04		1			H5216	023	0	2019	Cincinnati and Dayton Metro Areas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	024	0	1	04	01	H5216_024_0	4	1				07/11/2018	2019.01	07/11/2018 02:25:44 PM Eastern Daylight Time	07/17/2018 12:48:06 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-024 (PPO)	01	04		1			H5216	024	0	2019	Cleveland-Akron Metro Areas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	025	0	1	04	01	H5216_025_0	4	1				07/02/2018	2019.01	07/02/2018 11:50:54 AM Eastern Daylight Time	07/17/2018 10:12:06 AM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-025 (PPO)	01	04		1			H5216	025	0	2019	Northeast Virginia Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	026	0	1	04	01	H5216_026_0	4	1				07/02/2018	2019.01	07/02/2018 11:53:32 AM Eastern Daylight Time	07/17/2018 10:11:33 AM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-026 (PPO)	01	04		1			H5216	026	0	2019	Northern Virginia Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	027	0	1	04	01	H5216_027_0	4	1				07/02/2018	2019.01	07/02/2018 11:54:56 AM Eastern Daylight Time	07/17/2018 10:22:27 AM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-027 (PPO)	01	04		1			H5216	027	0	2019	Roanoke Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	028	0	1	04	01	H5216_028_0	4	1				07/02/2018	2019.01	07/02/2018 12:51:44 PM Eastern Daylight Time	07/17/2018 10:13:08 AM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:38:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-028 (PPO)	01	04		1			H5216	028	0	2019	Kent, New Castle and Sussex Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	029	0	1	04	01	H5216_029_0	4	1				07/02/2018	2019.01	07/02/2018 11:56:07 AM Eastern Daylight Time	07/17/2018 10:13:40 AM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-029 (PPO)	01	04		1			H5216	029	0	2019	Select Counties in Western Maryland		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	032	0	1	04	01	H5216_032_0	3	1				07/02/2018	2019.01	07/02/2018 01:36:38 PM Eastern Daylight Time	06/01/2018 02:55:21 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-032 (PPO)	01	04		1			H5216	032	0	2019	Select counties in Illinois, Kansas and Missouri		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	033	1	1	04	01	H5216_033_1	3	1				07/02/2018	2019.01	07/02/2018 01:08:02 PM Eastern Daylight Time	06/01/2018 02:57:08 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-033 (PPO)	01	04		1			H5216	033	1	2019	Select counties in Illinois, Kansas, and Missouri	Select counties in Kansas and Missouri	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	033	2	1	04	01	H5216_033_2	3	1				07/03/2018	2019.01	07/03/2018 01:32:37 PM Eastern Daylight Time	06/01/2018 03:15:07 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:00:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-033 (PPO)	01	04		1			H5216	033	2	2019	Select counties in Illinois, Kansas, and Missouri	Select counties in Illinois and Missouri	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	033	6	1	04	01	H5216_033_6	3	1				07/03/2018	2019.01	07/03/2018 01:42:25 PM Eastern Daylight Time	06/01/2018 03:22:12 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-033 (PPO)	01	04		1			H5216	033	6	2019	Select counties in Illinois, Kansas, and Missouri	Select counties in Kansas	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	034	0	1	04	01	H5216_034_0	5	1				07/16/2018	2019.01	07/16/2018 12:55:30 PM Eastern Daylight Time	07/17/2018 03:00:32 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-034 (PPO)	01	04		1			H5216	034	0	2019	Maricopa, Pima, Pinal and Santa Cruz counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	035	0	1	04	01	H5216_035_0	4	1				07/11/2018	2019.01	07/11/2018 01:37:09 PM Eastern Daylight Time	06/01/2018 03:16:26 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-035 (PPO)	01	04		1			H5216	035	0	2019	La Paz, Mohave and Yavapai counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	036	0	1	04	01	H5216_036_0	4	1				07/02/2018	2019.01	07/02/2018 12:37:25 PM Eastern Daylight Time	08/03/2018 03:59:49 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 09:52:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-036 (PPO)	01	04		1			H5216	036	0	2019	Clark and Nye (partial) counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	037	0	1	04	01	H5216_037_0	4	1				07/02/2018	2019.01	07/02/2018 12:39:02 PM Eastern Daylight Time	07/18/2018 01:56:38 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 09:52:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-037 (PPO)	01	04		1			H5216	037	0	2019	Clark and Nye (partial) counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	039	0	1	04	01	H5216_039_0	4	1				07/02/2018	2019.01	07/02/2018 12:40:32 PM Eastern Daylight Time	07/18/2018 02:09:20 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 09:52:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-039 (PPO)	01	04		1			H5216	039	0	2019	Washoe County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	040	0	1	04	01	H5216_040_0	3	1				07/02/2018	2019.01	07/02/2018 12:43:22 PM Eastern Daylight Time	06/01/2018 03:01:58 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 09:52:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-040 (PPO)	01	04		1			H5216	040	0	2019	Honolulu, Kauai and Maui counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	041	0	1	04	01	H5216_041_0	3	1				07/02/2018	2019.01	07/02/2018 12:44:02 PM Eastern Daylight Time	06/01/2018 03:03:18 PM Eastern Daylight Time	08/03/2018 09:21:07 AM Eastern Daylight Time			08/06/2018 09:52:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-041 (PPO)	01	04		1			H5216	041	0	2019	Honolulu, Kauai and Maui counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	042	0	1	04	01	H5216_042_0	4	1				07/11/2018	2019.01	07/11/2018 08:13:58 AM Eastern Daylight Time	06/01/2018 03:11:00 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-042 (PPO)	01	04		1			H5216	042	0	2019	Select Counties in Texas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	043	1	1	04	01	H5216_043_1	4	1				07/02/2018	2019.01	07/02/2018 04:35:46 PM Eastern Daylight Time	06/01/2018 03:12:20 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	01	04		1			H5216	043	1	2019	Select Counties in Texas	Select Counties in Texas	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	043	2	1	04	01	H5216_043_2	5	1				07/02/2018	2019.01	07/02/2018 04:37:03 PM Eastern Daylight Time	06/01/2018 03:13:00 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	01	04		1			H5216	043	2	2019	Select Counties in Texas	Select Counties in Texas	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	044	0	1	04	01	H5216_044_0	5	1				07/11/2018	2019.01	07/11/2018 02:16:29 PM Eastern Daylight Time	06/01/2018 02:27:26 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:35:12 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-044 (PPO)	01	04		1			H5216	044	0	2019	Select counties in Idaho and Oregon		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	045	0	1	04	01	H5216_045_0	3	1				07/05/2018	2019.01	07/05/2018 01:58:39 PM Eastern Daylight Time	06/01/2018 01:00:09 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-045 (PPO)	01	04		1			H5216	045	0	2019	Columbus Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	046	0	1	04	01	H5216_046_0	4	1				07/02/2018	2019.01	07/02/2018 12:40:07 PM Eastern Daylight Time	06/01/2018 02:27:54 PM Eastern Daylight Time				07/06/2018 02:55:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-046 (PPO)	01	04		1			H5216	046	0	2019	Select Counties in ID, OR, WA and UT		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	047	0	1	04	01	H5216_047_0	4	1				07/02/2018	2019.01	07/02/2018 02:26:29 PM Eastern Daylight Time	06/01/2018 02:30:43 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:35:12 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-047 (PPO)	01	04		1			H5216	047	0	2019	Select Counties in Washington and Oregon		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	048	0	1	04	01	H5216_048_0	4	1				07/02/2018	2019.01	07/02/2018 02:27:43 PM Eastern Daylight Time	06/01/2018 02:32:36 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:35:12 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-048 (PPO)	01	04		1			H5216	048	0	2019	Select Counties in ID, OR and WA		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	050	0	1	04	01	H5216_050_0	3	1				07/05/2018	2019.01	07/05/2018 01:57:28 PM Eastern Daylight Time	06/01/2018 01:02:03 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-050 (PPO)	01	04		1			H5216	050	0	2019	Northwest Ohio Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	051	0	1	04	01	H5216_051_0	3	1				07/05/2018	2019.01	07/05/2018 01:56:00 PM Eastern Daylight Time	06/01/2018 01:01:26 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:06:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-051 (PPO)	01	04		1			H5216	051	0	2019	Canton-Youngstown Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	052	1	1	04	01	H5216_052_1	3	1				07/05/2018	2019.01	07/05/2018 01:53:42 PM Eastern Daylight Time	06/01/2018 01:20:29 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	01	04		1			H5216	052	1	2019	Select counties in Ohio	Select counties in Ohio	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	052	2	1	04	01	H5216_052_2	3	1				07/05/2018	2019.01	07/05/2018 01:52:13 PM Eastern Daylight Time	06/01/2018 01:19:18 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	01	04		1			H5216	052	2	2019	Select counties in Ohio	Select counties in northwest West Virginia	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	053	0	1	04	01	H5216_053_0	3	1				07/05/2018	2019.01	07/05/2018 01:50:18 PM Eastern Daylight Time	06/01/2018 01:02:41 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-053 (PPO)	01	04		1			H5216	053	0	2019	Central Indiana Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	054	0	1	04	01	H5216_054_0	3	1				07/05/2018	2019.01	07/05/2018 01:48:24 PM Eastern Daylight Time	06/01/2018 12:58:53 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-054 (PPO)	01	04		1			H5216	054	0	2019	Southern Indiana Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	055	0	1	04	01	H5216_055_0	3	1				07/06/2018	2019.01	07/06/2018 10:48:07 AM Eastern Daylight Time	06/01/2018 12:59:31 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-055 (PPO)	01	04		1			H5216	055	0	2019	Northern Indiana Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	057	0	1	04	01	H5216_057_0	5	1				07/18/2018	2019.01	07/18/2018 03:44:48 PM Eastern Daylight Time	06/01/2018 03:12:41 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 09:55:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-057 (PPO)	01	04		1			H5216	057	0	2019	Select Counties in New Hampshire		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	058	0	1	04	01	H5216_058_0	5	1				07/18/2018	2019.01	07/18/2018 03:44:33 PM Eastern Daylight Time	06/01/2018 03:14:33 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 09:55:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-058 (PPO)	01	04		1			H5216	058	0	2019	Select Counties in New Hampshire		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	059	0	1	04	01	H5216_059_0	2	1				07/02/2018	2019.01	07/02/2018 12:03:24 PM Eastern Daylight Time	06/01/2018 03:15:02 PM Eastern Daylight Time				07/06/2018 02:39:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-059 (PPO)	01	04		1			H5216	059	0	2019	Select Counties in Maine and New Hampshire		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	060	0	1	04	01	H5216_060_0	5	1				07/18/2018	2019.01	07/18/2018 03:42:49 PM Eastern Daylight Time	07/18/2018 02:06:01 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-060 (PPO)	01	04		1			H5216	060	0	2019	Martin and St. Lucie counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	061	0	1	04	01	H5216_061_0	5	1				07/11/2018	2019.01	07/11/2018 03:15:27 PM Eastern Daylight Time	07/18/2018 02:08:38 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 11:12:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-061 (PPO)	01	04		1			H5216	061	0	2019	Select Counties in Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	062	0	1	04	01	H5216_062_0	5	1				07/11/2018	2019.01	07/11/2018 01:47:31 PM Eastern Daylight Time	07/18/2018 02:09:11 PM Eastern Daylight Time	08/03/2018 09:21:08 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-062 (PPO)	01	04		1			H5216	062	0	2019	Select Counties in Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	063	0	1	04	01	H5216_063_0	5	1				07/05/2018	2019.01	07/05/2018 02:18:16 PM Eastern Daylight Time	08/03/2018 06:33:49 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-063 (PPO)	01	04		1			H5216	063	0	2019	Select Counties in Minnesota		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	064	0	1	04	01	H5216_064_0	3	1				07/02/2018	2019.01	07/02/2018 11:58:02 AM Eastern Daylight Time	06/01/2018 03:24:27 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-064 (PPO)	01	04		1			H5216	064	0	2019	Select Louisiana Parishes		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	065	0	1	04	01	H5216_065_0	5	1				07/18/2018	2019.01	07/18/2018 03:46:51 PM Eastern Daylight Time	07/18/2018 02:05:30 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-065 (PPO)	01	04		1			H5216	065	0	2019	Broward, Miami-Dade and Palm Beach Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	066	0	1	04	01	H5216_066_0	3	1				07/02/2018	2019.01	07/02/2018 12:09:24 PM Eastern Daylight Time	06/01/2018 03:23:28 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:06:26 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-066 (PPO)	01	04		1			H5216	066	0	2019	Gulf Coast / Biloxi Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	067	0	1	04	01	H5216_067_0	3	1				07/02/2018	2019.01	07/02/2018 01:01:11 PM Eastern Daylight Time	06/01/2018 03:23:57 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-067 (PPO)	01	04		1			H5216	067	0	2019	Select Counties in Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	068	0	1	04	01	H5216_068_0	5	1				07/11/2018	2019.01	07/11/2018 03:01:26 PM Eastern Daylight Time	07/18/2018 02:08:07 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-068 (PPO)	01	04		1			H5216	068	0	2019	Broward, Miami-Dade and Palm Beach Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	070	0	1	04	01	H5216_070_0	5	1				07/11/2018	2019.01	07/11/2018 03:22:14 PM Eastern Daylight Time	08/03/2018 11:50:39 AM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 11:12:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-070 (PPO)	01	04		1			H5216	070	0	2019	Select Counties in Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	071	0	1	04	01	H5216_071_0	3	1				07/02/2018	2019.01	07/02/2018 01:25:37 PM Eastern Daylight Time	06/01/2018 03:13:16 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-071 (PPO)	01	04		1			H5216	071	0	2019	Counties:  Cobb, Paulding, Douglas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	072	0	1	04	01	H5216_072_0	5	1				07/11/2018	2019.01	07/11/2018 02:08:50 PM Eastern Daylight Time	07/18/2018 02:06:32 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 11:12:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-072 (PPO)	01	04		1			H5216	072	0	2019	Select Counties in Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	073	0	1	04	01	H5216_073_0	3	1				07/02/2018	2019.01	07/02/2018 01:26:26 PM Eastern Daylight Time	06/01/2018 03:06:00 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-073 (PPO)	01	04		1			H5216	073	0	2019	Atlanta Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	074	0	1	04	01	H5216_074_0	5	1				07/11/2018	2019.01	07/11/2018 02:31:53 PM Eastern Daylight Time	07/18/2018 02:07:03 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 11:12:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-074 (PPO)	01	04		1			H5216	074	0	2019	Lake, Marion and Sumter counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	075	0	1	04	01	H5216_075_0	4	1				07/02/2018	2019.01	07/02/2018 12:40:03 PM Eastern Daylight Time	06/01/2018 03:07:02 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-075 (PPO)	01	04		1			H5216	075	0	2019	Charleston Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	076	0	1	04	01	H5216_076_0	3	1				07/02/2018	2019.01	07/02/2018 12:40:27 PM Eastern Daylight Time	06/01/2018 03:08:09 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-076 (PPO)	01	04		1			H5216	076	0	2019	Spartanburg/Greenville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	077	0	1	04	01	H5216_077_0	5	1				07/16/2018	2019.01	07/16/2018 01:10:12 PM Eastern Daylight Time	07/17/2018 02:58:56 PM Eastern Daylight Time				07/18/2018 04:23:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-077 (PPO)	01	04		1			H5216	077	0	2019	Select Counties in Colorado and New Mexico		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						1	01	4b;8a1;8a2;8b3;	
H5216	078	1	1	04	01	H5216_078_1	5	1				07/02/2018	2019.01	07/02/2018 04:39:38 PM Eastern Daylight Time	08/03/2018 01:38:10 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	01	04		1			H5216	078	1	2019	Select Counties in Colorado	Select Counties in Colorado	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H5216	078	2	1	04	01	H5216_078_2	4	1				07/02/2018	2019.01	07/02/2018 04:41:31 PM Eastern Daylight Time	08/03/2018 01:38:52 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	01	04		1			H5216	078	2	2019	Select Counties in Colorado	Colorado Springs/Grand Junction	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H5216	080	1	1	04	01	H5216_080_1	5	1				07/05/2018	2019.01	07/05/2018 02:25:49 PM Eastern Daylight Time	07/18/2018 03:06:07 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	01	04		1			H5216	080	1	2019	Select Counties in Minnesota and Wisconsin	Twin Cities	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	080	2	1	04	01	H5216_080_2	5	1				07/05/2018	2019.01	07/05/2018 02:31:27 PM Eastern Daylight Time	07/18/2018 03:06:38 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	01	04		1			H5216	080	2	2019	Select Counties in Minnesota and Wisconsin	Rochester	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	080	3	1	04	01	H5216_080_3	5	1				07/05/2018	2019.01	07/05/2018 02:36:17 PM Eastern Daylight Time	07/18/2018 03:08:35 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:53:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	01	04		1			H5216	080	3	2019	Select Counties in Minnesota and Wisconsin	Duluth	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	081	0	1	04	01	H5216_081_0	4	1				07/17/2018	2019.01	07/17/2018 04:26:58 PM Eastern Daylight Time	07/18/2018 02:18:50 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-081 (PPO)	01	04		1			H5216	081	0	2019	Select counties in Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	083	0	1	04	01	H5216_083_0	3	1				07/02/2018	2019.01	07/02/2018 02:31:20 PM Eastern Daylight Time	06/01/2018 03:08:33 PM Eastern Daylight Time	08/03/2018 09:21:09 AM Eastern Daylight Time			08/06/2018 10:35:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-083 (PPO)	01	04		1			H5216	083	0	2019	Select counties in AR, KS, MO, and OK		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	085	0	1	04	01	H5216_085_0	5	1				07/05/2018	2019.01	07/05/2018 02:43:53 PM Eastern Daylight Time	07/18/2018 02:55:25 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-085 (PPO)	01	04		1			H5216	085	0	2019	Omaha Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	086	0	1	04	01	H5216_086_0	4	1				07/05/2018	2019.01	07/05/2018 02:49:45 PM Eastern Daylight Time	07/18/2018 03:00:43 PM Eastern Daylight Time				07/18/2018 06:14:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-086 (PPO)	01	04		1			H5216	086	0	2019	Select Counties in IA, MN, MT, ND, NE, SD		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	088	0	1	04	01	H5216_088_0	5	1				07/05/2018	2019.01	07/05/2018 02:58:41 PM Eastern Daylight Time	07/18/2018 02:57:17 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-088 (PPO)	01	04		1			H5216	088	0	2019	Select Counties in North and South Dakota		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	089	0	1	04	01	H5216_089_0	5	1				07/05/2018	2019.01	07/05/2018 03:07:09 PM Eastern Daylight Time	07/18/2018 03:02:43 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-089 (PPO)	01	04		1			H5216	089	0	2019	Select Counties in Montana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	091	0	1	04	01	H5216_091_0	5	1				07/05/2018	2019.01	07/05/2018 03:12:49 PM Eastern Daylight Time	07/18/2018 03:04:12 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-091 (PPO)	01	04		1			H5216	091	0	2019	Select Counties in Iowa		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	092	0	1	04	01	H5216_092_0	5	1				07/05/2018	2019.01	07/05/2018 03:20:07 PM Eastern Daylight Time	07/18/2018 03:07:09 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-092 (PPO)	01	04		1			H5216	092	0	2019	Select Counties in MN, ND and SD		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	093	0	1	04	01	H5216_093_0	4	1				07/02/2018	2019.01	07/02/2018 02:40:58 PM Eastern Daylight Time	06/01/2018 01:34:16 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-093 (PPO)	01	04		1			H5216	093	0	2019	Memphis Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	094	0	1	04	01	H5216_094_0	3	1				07/02/2018	2019.01	07/02/2018 03:07:02 PM Eastern Daylight Time	06/01/2018 01:37:45 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:40:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-094 (PPO)	01	04		1			H5216	094	0	2019	Select Counties in Alabama		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	095	0	1	04	01	H5216_095_0	3	1				07/05/2018	2019.01	07/05/2018 05:07:19 PM Eastern Daylight Time	06/01/2018 01:36:29 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-095 (PPO)	01	04		1			H5216	095	0	2019	Select Counties in Alabama		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	096	0	1	04	01	H5216_096_0	3	1				07/02/2018	2019.01	07/02/2018 05:44:06 PM Eastern Daylight Time	06/01/2018 01:36:54 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-096 (PPO)	01	04		1			H5216	096	0	2019	Dothan Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	097	0	1	04	01	H5216_097_0	3	1				07/02/2018	2019.01	07/02/2018 03:10:31 PM Eastern Daylight Time	06/01/2018 01:34:42 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-097 (PPO)	01	04		1			H5216	097	0	2019	Nashville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	098	0	1	04	01	H5216_098_0	4	1				07/16/2018	2019.01	07/16/2018 01:37:06 PM Eastern Daylight Time	08/03/2018 12:19:28 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-098 (PPO)	01	04		1			H5216	098	0	2019	Chattanooga Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	099	0	1	04	01	H5216_099_0	4	1				07/18/2018	2019.01	07/18/2018 01:47:12 PM Eastern Daylight Time	08/03/2018 12:19:51 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-099 (PPO)	01	04		1			H5216	099	0	2019	Knoxville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	100	0	1	04	01	H5216_100_0	3	1				07/02/2018	2019.01	07/02/2018 03:16:36 PM Eastern Daylight Time	06/01/2018 01:36:02 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-100 (PPO)	01	04		1			H5216	100	0	2019	Select Counties in the Tri-Cities Area of Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	103	0	1	04	01	H5216_103_0	5	1				07/05/2018	2019.01	07/05/2018 03:25:27 PM Eastern Daylight Time	07/18/2018 03:11:02 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-103 (PPO)	01	04		1			H5216	103	0	2019	Select Counties in North Dakota and South Dakota		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	104	0	1	04	01	H5216_104_0	5	1				07/05/2018	2019.01	07/05/2018 03:35:10 PM Eastern Daylight Time	07/18/2018 03:11:30 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-104 (PPO)	01	04		1			H5216	104	0	2019	Dallas and Polk counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	105	0	1	04	01	H5216_105_0	2	1				07/05/2018	2019.01	07/05/2018 02:55:59 PM Eastern Daylight Time	06/01/2018 01:47:25 PM Eastern Daylight Time				07/06/2018 04:35:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-105 (PPO)	01	04		1			H5216	105	0	2019	Select counties in Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	106	0	1	04	01	H5216_106_0	3	1				07/05/2018	2019.01	07/05/2018 01:45:38 PM Eastern Daylight Time	06/01/2018 01:21:06 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-106 (PPO)	01	04		1			H5216	106	0	2019	Select counties in Northeast Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	107	0	1	04	01	H5216_107_0	4	1				07/11/2018	2019.01	07/11/2018 12:10:42 PM Eastern Daylight Time	06/01/2018 01:42:50 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-107 (PPO)	01	04		1			H5216	107	0	2019	Select counties in Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	108	0	1	04	01	H5216_108_0	3	1				07/05/2018	2019.01	07/05/2018 01:44:18 PM Eastern Daylight Time	06/01/2018 01:21:42 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-108 (PPO)	01	04		1			H5216	108	0	2019	Select counties in Northwest Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	109	0	1	04	01	H5216_109_0	3	1				07/05/2018	2019.01	07/05/2018 01:41:37 PM Eastern Daylight Time	06/01/2018 01:22:55 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-109 (PPO)	01	04		1			H5216	109	0	2019	Select counties in Southwest Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	110	0	1	04	01	H5216_110_0	3	1				07/05/2018	2019.01	07/05/2018 01:39:06 PM Eastern Daylight Time	08/03/2018 01:40:21 PM Eastern Daylight Time	08/03/2018 09:21:10 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-110 (PPO)	01	04		1			H5216	110	0	2019	Select counties in Southeast Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	111	0	1	04	01	H5216_111_0	3	1				07/05/2018	2019.01	07/05/2018 01:35:14 PM Eastern Daylight Time	06/01/2018 01:23:32 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:14:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-111 (PPO)	01	04		1			H5216	111	0	2019	Select counties in Northwest and Central IN		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	112	0	1	04	01	H5216_112_0	3	1				07/05/2018	2019.01	07/05/2018 01:28:39 PM Eastern Daylight Time	06/01/2018 01:25:20 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-112 (PPO)	01	04		1			H5216	112	0	2019	Select counties in Northeast and Fort Wayne IN		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	113	0	1	04	01	H5216_113_0	3	1				08/03/2018	2019.01	08/03/2018 11:40:16 AM Eastern Daylight Time	06/01/2018 01:24:08 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-113 (PPO)	01	04		1			H5216	113	0	2019	Select counties in Southern Indiana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	114	0	1	04	01	H5216_114_0	3	1				07/05/2018	2019.01	07/05/2018 01:24:28 PM Eastern Daylight Time	06/01/2018 01:24:44 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-114 (PPO)	01	04		1			H5216	114	0	2019	Select counties in Indianapolis		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	115	0	1	04	01	H5216_115_0	3	1				07/05/2018	2019.01	07/05/2018 03:58:47 PM Eastern Daylight Time	08/03/2018 03:29:33 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-115 (PPO)	01	04		1			H5216	115	0	2019	Select counties in Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	116	0	1	04	01	H5216_116_0	2	1				07/05/2018	2019.01	07/05/2018 04:00:34 PM Eastern Daylight Time	06/01/2018 01:47:53 PM Eastern Daylight Time				07/06/2018 04:35:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-116 (PPO)	01	04		1			H5216	116	0	2019	Select counties in Pennsylvania		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	117	0	1	04	01	H5216_117_0	3	1				07/05/2018	2019.01	07/05/2018 01:12:48 PM Eastern Daylight Time	08/03/2018 03:30:48 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-117 (PPO)	01	04		1			H5216	117	0	2019	Select counties in Pennsylvania		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	119	0	1	04	01	H5216_119_0	5	1				07/18/2018	2019.01	07/18/2018 05:52:17 PM Eastern Daylight Time	06/01/2018 01:43:44 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-119 (PPO)	01	04		1			H5216	119	0	2019	Western Pennsylvania Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	120	0	1	04	01	H5216_120_0	5	1				07/18/2018	2019.01	07/18/2018 04:52:12 PM Eastern Daylight Time	08/03/2018 03:31:55 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:48:06 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-120 (PPO)	01	04		1			H5216	120	0	2019	South Central Pennsylvania Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	121	0	1	04	01	H5216_121_0	5	1				07/18/2018	2019.01	07/18/2018 05:05:31 PM Eastern Daylight Time	06/01/2018 01:46:56 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-121 (PPO)	01	04		1			H5216	121	0	2019	North Central Pennsylvania Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	122	0	1	04	01	H5216_122_0	4	1				07/11/2018	2019.01	07/11/2018 05:21:05 PM Eastern Daylight Time	06/01/2018 01:46:01 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-122 (PPO)	01	04		1			H5216	122	0	2019	Greater Philadelphia Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	123	0	1	04	01	H5216_123_0	2	1				07/05/2018	2019.01	07/05/2018 01:12:23 PM Eastern Daylight Time	06/01/2018 01:48:20 PM Eastern Daylight Time				07/06/2018 04:42:39 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-123 (PPO)	01	04		1			H5216	123	0	2019	Select counties in West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	124	0	1	04	01	H5216_124_0	5	1				07/18/2018	2019.01	07/18/2018 04:51:00 PM Eastern Daylight Time	06/01/2018 01:43:17 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-124 (PPO)	01	04		1			H5216	124	0	2019	Select counties in West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	125	0	1	04	01	H5216_125_0	3	1				07/05/2018	2019.01	07/05/2018 01:09:48 PM Eastern Daylight Time	06/01/2018 01:45:07 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-125 (PPO)	01	04		1			H5216	125	0	2019	Select counties in West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	127	0	1	04	01	H5216_127_0	3	1				07/02/2018	2019.01	07/02/2018 12:52:02 PM Eastern Daylight Time	07/17/2018 10:24:28 AM Eastern Daylight Time				07/18/2018 04:46:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-127 (PPO)	01	04		1			H5216	127	0	2019	Kent, New Castle and Sussex Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	128	0	1	04	01	H5216_128_0	2	1				07/02/2018	2019.01	07/02/2018 04:35:29 PM Eastern Daylight Time	06/01/2018 03:11:41 PM Eastern Daylight Time				07/06/2018 02:11:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-128 (PPO)	01	04		1			H5216	128	0	2019	Select Counties in Texas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	129	0	1	04	01	H5216_129_0	3	1				07/02/2018	2019.01	07/02/2018 11:58:45 AM Eastern Daylight Time	07/17/2018 10:20:27 AM Eastern Daylight Time				07/18/2018 04:30:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-129 (PPO)	01	04		1			H5216	129	0	2019	Select Counties in Western Maryland		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	131	0	1	04	01	H5216_131_0	4	1				07/02/2018	2019.01	07/02/2018 02:28:07 PM Eastern Daylight Time	06/01/2018 02:39:14 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:35:12 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-131 (PPO)	01	04		1			H5216	131	0	2019	Davis, Salt Lake, Utah and Weber Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	132	0	1	04	01	H5216_132_0	4	1				07/02/2018	2019.01	07/02/2018 02:29:07 PM Eastern Daylight Time	06/01/2018 02:39:42 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-132 (PPO)	01	04		1			H5216	132	0	2019	Select Counties in Idaho and Malheur County Oregon		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	133	0	1	04	01	H5216_133_0	4	1				07/11/2018	2019.01	07/11/2018 02:27:07 PM Eastern Daylight Time	06/01/2018 01:27:41 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-133 (PPO)	01	04		1			H5216	133	0	2019	Macomb, Oakland and Wayne counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	135	0	1	04	01	H5216_135_0	3	1				07/02/2018	2019.01	07/02/2018 01:01:35 PM Eastern Daylight Time	06/01/2018 03:25:27 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-135 (PPO)	01	04		1			H5216	135	0	2019	Select Louisiana Parishes		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	136	0	1	04	01	H5216_136_0	3	1				07/02/2018	2019.01	07/02/2018 01:05:36 PM Eastern Daylight Time	06/01/2018 03:27:03 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-136 (PPO)	01	04		1			H5216	136	0	2019	Select Counties in Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	137	0	1	04	01	H5216_137_0	4	1				07/02/2018	2019.01	07/02/2018 04:43:02 PM Eastern Daylight Time	06/01/2018 03:20:41 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-137 (PPO)	01	04		1			H5216	137	0	2019	Select Counties in New Mexico		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	138	0	1	04	01	H5216_138_0	3	1				07/02/2018	2019.01	07/02/2018 12:03:46 PM Eastern Daylight Time	06/01/2018 03:16:27 PM Eastern Daylight Time	08/03/2018 09:21:11 AM Eastern Daylight Time			08/06/2018 09:55:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-138 (PPO)	01	04		1			H5216	138	0	2019	Select Counties in New Hampshire		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	139	0	1	04	01	H5216_139_0	3	1				07/02/2018	2019.01	07/02/2018 04:05:38 PM Eastern Daylight Time	06/01/2018 03:19:11 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:35:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-139 (PPO)	01	04		1			H5216	139	0	2019	Select counties in Arkansas and Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	140	0	1	04	01	H5216_140_0	2	1				07/02/2018	2019.01	07/02/2018 02:38:45 PM Eastern Daylight Time	06/01/2018 03:11:52 PM Eastern Daylight Time				07/06/2018 02:10:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-140 (PPO)	01	04		1			H5216	140	0	2019	Select counties in AR, IL, KS, MO, and OK		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	141	0	1	04	01	H5216_141_0	4	1				07/02/2018	2019.01	07/02/2018 12:45:42 PM Eastern Daylight Time	07/18/2018 02:05:15 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 09:52:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-141 (PPO)	01	04		1			H5216	141	0	2019	Clark and Nye (partial) counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	142	1	1	04	01	H5216_142_1	3	1				07/02/2018	2019.01	07/02/2018 01:48:26 PM Eastern Daylight Time	06/01/2018 03:21:33 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:02:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	01	04		1			H5216	142	1	2019	select counties in Georgia and South Carolina	Columbia	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	142	2	1	04	01	H5216_142_2	3	1				07/02/2018	2019.01	07/02/2018 01:27:19 PM Eastern Daylight Time	06/01/2018 03:22:50 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:13:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	01	04		1			H5216	142	2	2019	select counties in Georgia and South Carolina	select counties in Georgia and South Carolina	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	143	0	1	04	01	H5216_143_0	4	1				07/18/2018	2019.01	07/18/2018 03:37:52 PM Eastern Daylight Time	06/01/2018 03:32:30 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:13:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-143 (PPO)	01	04		1			H5216	143	0	2019	Hall County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	144	0	1	04	01	H5216_144_0	4	1				07/02/2018	2019.01	07/02/2018 12:01:25 PM Eastern Daylight Time	07/17/2018 10:29:56 AM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-144 (PPO)	01	04		1			H5216	144	0	2019	Tidewater Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	145	0	1	04	01	H5216_145_0	3	1				07/02/2018	2019.01	07/02/2018 01:27:45 PM Eastern Daylight Time	06/01/2018 03:30:03 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:13:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-145 (PPO)	01	04		1			H5216	145	0	2019	Select Counties in Georgia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	146	0	1	04	01	H5216_146_0	4	1				07/02/2018	2019.01	07/02/2018 12:03:25 PM Eastern Daylight Time	07/17/2018 10:29:26 AM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-146 (PPO)	01	04		1			H5216	146	0	2019	Richmond Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	147	0	1	04	01	H5216_147_0	3	1				07/02/2018	2019.01	07/02/2018 01:28:10 PM Eastern Daylight Time	06/01/2018 03:31:23 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:13:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-147 (PPO)	01	04		1			H5216	147	0	2019	Select Counties in Georgia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	148	0	1	04	01	H5216_148_0	4	1				07/03/2018	2019.01	07/03/2018 03:02:19 PM Eastern Daylight Time	07/17/2018 10:30:58 AM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-148 (PPO)	01	04		1			H5216	148	0	2019	Central Virginia Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	149	0	1	04	01	H5216_149_0	4	1				07/02/2018	2019.01	07/02/2018 04:00:16 PM Eastern Daylight Time	07/17/2018 10:26:55 AM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-149 (PPO)	01	04		1			H5216	149	0	2019	Lynchburg - Winchester Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	150	0	1	04	01	H5216_150_0	4	1				07/02/2018	2019.01	07/02/2018 12:11:29 PM Eastern Daylight Time	08/03/2018 09:56:17 AM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-150 (PPO)	01	04		1			H5216	150	0	2019	Winchester Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	151	0	1	04	01	H5216_151_0	4	1				07/03/2018	2019.01	07/03/2018 10:28:01 AM Eastern Daylight Time	07/17/2018 10:34:27 AM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:11:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-151 (PPO)	01	04		1			H5216	151	0	2019	Fredericksburg Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	152	0	1	04	01	H5216_152_0	3	1				07/03/2018	2019.01	07/03/2018 03:06:58 PM Eastern Daylight Time	07/17/2018 10:33:51 AM Eastern Daylight Time				07/18/2018 04:30:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-152 (PPO)	01	04		1			H5216	152	0	2019	Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	153	0	1	04	01	H5216_153_0	4	1				07/11/2018	2019.01	07/11/2018 02:52:51 PM Eastern Daylight Time	06/01/2018 03:33:43 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-153 (PPO)	01	04		1			H5216	153	0	2019	Charleston Berkley Dorchester Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	154	0	1	04	01	H5216_154_0	3	1				07/02/2018	2019.01	07/02/2018 12:42:53 PM Eastern Daylight Time	06/01/2018 03:35:27 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-154 (PPO)	01	04		1			H5216	154	0	2019	Select Counties in Georgia and South Carolina		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	155	0	1	04	01	H5216_155_0	3	1				07/02/2018	2019.01	07/02/2018 12:44:30 PM Eastern Daylight Time	06/01/2018 03:36:29 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-155 (PPO)	01	04		1			H5216	155	0	2019	Georgia and South Carolina Coastal		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	156	0	1	04	01	H5216_156_0	3	1				07/02/2018	2019.01	07/02/2018 12:48:40 PM Eastern Daylight Time	06/01/2018 03:37:34 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-156 (PPO)	01	04		1			H5216	156	0	2019	Georgia and South Carolina Coastal		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	157	0	1	04	01	H5216_157_0	3	1				07/11/2018	2019.01	07/11/2018 03:04:10 PM Eastern Daylight Time	06/01/2018 03:39:14 PM Eastern Daylight Time				07/12/2018 02:24:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-157 (PPO)	01	04		1			H5216	157	0	2019	Select Counties in Georgia and South Carolina		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	158	0	1	04	01	H5216_158_0	4	1				07/02/2018	2019.01	07/02/2018 03:47:47 PM Eastern Daylight Time	06/04/2018 10:47:50 AM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-158 (PPO)	01	04		1			H5216	158	0	2019	Select Counties in Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	159	0	1	04	01	H5216_159_0	3	1				07/02/2018	2019.01	07/02/2018 03:48:00 PM Eastern Daylight Time	06/01/2018 03:29:03 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-159 (PPO)	01	04		1			H5216	159	0	2019	Select Counties in Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	160	0	1	04	01	H5216_160_0	3	1				08/01/2018	2019.01	08/01/2018 05:19:17 PM Eastern Daylight Time	08/03/2018 12:43:57 PM Eastern Daylight Time	08/03/2018 09:21:12 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-160 (PPO)	01	04		1			H5216	160	0	2019	Select Counties in Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	161	0	1	04	01	H5216_161_0	3	1				07/02/2018	2019.01	07/02/2018 03:48:22 PM Eastern Daylight Time	06/01/2018 03:30:02 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-161 (PPO)	01	04		1			H5216	161	0	2019	Select Louisiana Parishes		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	163	0	1	04	01	H5216_163_0	3	1				07/03/2018	2019.01	07/03/2018 02:28:19 PM Eastern Daylight Time	06/01/2018 02:26:19 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-163 (PPO)	01	04		1			H5216	163	0	2019	Select counties in Arkansas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	164	0	1	04	01	H5216_164_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 03:26:35 PM Eastern Daylight Time	08/03/2018 06:12:37 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-164 (PPO SNP)	01	04		1			H5216	164	0	2019	Select counties in Missouri		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	165	0	1	04	01	H5216_165_0	4	1				08/01/2018	2019.01	08/01/2018 03:26:58 PM Eastern Daylight Time	08/03/2018 06:20:43 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-165 (PPO)	01	04		1			H5216	165	0	2019	Select counties in Arkansas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	166	0	1	04	01	H5216_166_0	4	1				08/01/2018	2019.01	08/01/2018 03:27:19 PM Eastern Daylight Time	08/03/2018 06:07:43 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-166 (PPO)	01	04		1			H5216	166	0	2019	Select counties in Kansas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	167	0	1	04	01	H5216_167_0	5	1				07/05/2018	2019.01	07/05/2018 03:40:41 PM Eastern Daylight Time	07/18/2018 03:12:28 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-167 (PPO)	01	04		1			H5216	167	0	2019	Select Counties in Minnesota		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	168	0	1	04	01	H5216_168_0	6	1				07/18/2018	2019.01	07/18/2018 03:35:36 PM Eastern Daylight Time	07/18/2018 03:12:55 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-168 (PPO)	01	04		1			H5216	168	0	2019	Select Counties in Wisconsin		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	169	0	1	04	01	H5216_169_0	4	1				07/11/2018	2019.01	07/11/2018 12:07:54 PM Eastern Daylight Time	06/01/2018 03:22:50 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 09:59:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-169 (PPO)	01	04		1			H5216	169	0	2019	Bergen, Hudson and Morris counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	170	0	1	04	01	H5216_170_0	4	1				07/11/2018	2019.01	07/11/2018 12:09:08 PM Eastern Daylight Time	06/01/2018 03:22:17 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 09:59:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-170 (PPO)	01	04		1			H5216	170	0	2019	Bergen, Hudson and Morris counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	171	0	1	04	01	H5216_171_0	5	1				07/05/2018	2019.01	07/05/2018 03:46:57 PM Eastern Daylight Time	07/18/2018 03:13:25 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-171 (PPO)	01	04		1			H5216	171	0	2019	Select Counties in IA, NE, ND, and SD		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	172	0	1	04	01	H5216_172_0	4	1				07/11/2018	2019.01	07/11/2018 12:10:47 PM Eastern Daylight Time	06/01/2018 03:23:55 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 09:59:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-172 (PPO)	01	04		1			H5216	172	0	2019	Bergen, Hudson and Morris counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	173	0	1	04	01	H5216_173_0	5	1				07/05/2018	2019.01	07/05/2018 03:53:38 PM Eastern Daylight Time	07/18/2018 03:13:53 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-173 (PPO)	01	04		1			H5216	173	0	2019	Select Counties in Wisconsin		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	174	0	1	04	01	H5216_174_0	3	1				07/11/2018	2019.01	07/11/2018 12:11:58 PM Eastern Daylight Time	06/01/2018 03:23:22 PM Eastern Daylight Time				07/12/2018 02:12:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-174 (PPO)	01	04		1			H5216	174	0	2019	Bergen, Hudson and Morris counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	175	0	1	04	01	H5216_175_0	5	1				07/18/2018	2019.01	07/18/2018 03:52:49 PM Eastern Daylight Time	06/01/2018 03:24:28 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 09:59:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-175 (PPO)	01	04		1			H5216	175	0	2019	Select Counties in Maine		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	176	0	1	04	01	H5216_176_0	5	1				07/05/2018	2019.01	07/05/2018 04:03:02 PM Eastern Daylight Time	07/18/2018 03:15:49 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-176 (PPO)	01	04		1			H5216	176	0	2019	Select Counties in Minnesota		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	177	0	1	04	01	H5216_177_0	5	1				07/18/2018	2019.01	07/18/2018 03:54:04 PM Eastern Daylight Time	06/01/2018 03:25:00 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 09:59:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-177 (PPO)	01	04		1			H5216	177	0	2019	Select Counties in Maine		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	178	1	1	04	01	H5216_178_1	4	1				07/05/2018	2019.01	07/05/2018 04:12:38 PM Eastern Daylight Time	07/18/2018 03:14:51 PM Eastern Daylight Time				07/18/2018 06:14:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-178 (PPO)	01	04		1			H5216	178	1	2019	Select Counties in IL, MI and WI	Select Counties in Illinois and Wisconsin	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	178	2	1	04	01	H5216_178_2	4	1				07/17/2018	2019.01	07/17/2018 10:12:53 AM Eastern Daylight Time	07/18/2018 03:15:20 PM Eastern Daylight Time				07/18/2018 06:14:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-178 (PPO)	01	04		1			H5216	178	2	2019	Select Counties in IL, MI and WI	Select Counties in Michigan	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	179	0	1	04	01	H5216_179_0	4	1				08/01/2018	2019.01	08/01/2018 02:37:35 PM Eastern Daylight Time	08/03/2018 12:20:38 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-179 (PPO)	01	04		1			H5216	179	0	2019	Select Counties in Alabama		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	180	0	1	04	01	H5216_180_0	4	1				07/11/2018	2019.01	07/11/2018 03:56:36 PM Eastern Daylight Time	08/03/2018 12:20:15 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-180 (PPO)	01	04		1			H5216	180	0	2019	Select Counties in TN		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	181	0	1	04	01	H5216_181_0	4	1				07/11/2018	2019.01	07/11/2018 03:56:58 PM Eastern Daylight Time	08/03/2018 12:21:03 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-181 (PPO)	01	04		1			H5216	181	0	2019	Select VA Counties in the Tri-Cities Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	182	0	1	04	01	H5216_182_0	3	1				07/05/2018	2019.01	07/05/2018 01:10:04 PM Eastern Daylight Time	06/01/2018 01:53:16 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-182 (PPO)	01	04		1			H5216	182	0	2019	West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	183	0	1	04	01	H5216_183_0	3	1				07/16/2018	2019.01	07/16/2018 01:29:25 PM Eastern Daylight Time	07/18/2018 03:07:29 PM Eastern Daylight Time				07/18/2018 04:21:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-183 (PPO)	01	04		1			H5216	183	0	2019	Select Counties in New Jersey		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	184	0	1	04	01	H5216_184_0	3	1				07/05/2018	2019.01	07/05/2018 01:10:42 PM Eastern Daylight Time	06/01/2018 01:54:10 PM Eastern Daylight Time	08/03/2018 09:21:13 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-184 (PPO)	01	04		1			H5216	184	0	2019	Select Counties in New Jersey		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	185	0	1	04	01	H5216_185_0	3	1				07/05/2018	2019.01	07/05/2018 01:11:08 PM Eastern Daylight Time	06/01/2018 01:54:37 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-185 (PPO)	01	04		1			H5216	185	0	2019	Select Counties in New Jersey		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	186	0	1	04	01	H5216_186_0	3	1				07/05/2018	2019.01	07/05/2018 01:11:30 PM Eastern Daylight Time	06/01/2018 01:55:05 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-186 (PPO)	01	04		1			H5216	186	0	2019	Select Counties in New Jersey		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	187	0	1	04	01	H5216_187_0	5	1				07/11/2018	2019.01	07/11/2018 12:17:10 PM Eastern Daylight Time	06/01/2018 01:50:34 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-187 (PPO)	01	04		1			H5216	187	0	2019	Louisville and Lexington Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	188	0	1	04	01	H5216_188_0	3	1				07/05/2018	2019.01	07/05/2018 01:11:58 PM Eastern Daylight Time	06/01/2018 01:50:08 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:00:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-188 (PPO)	01	04		1			H5216	188	0	2019	Select Counties in Indiana and Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	189	0	1	04	01	H5216_189_0	4	1				07/02/2018	2019.01	07/02/2018 02:29:35 PM Eastern Daylight Time	08/03/2018 02:11:12 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-189 (PPO)	01	04		1			H5216	189	0	2019	Washington County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	190	0	1	04	01	H5216_190_0	5	1				07/23/2018	2019.01	07/23/2018 02:28:40 PM Eastern Daylight Time	06/01/2018 01:29:32 PM Eastern Daylight Time				07/23/2018 04:25:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-190 (PPO)	01	04		1			H5216	190	0	2019	Select counties in Michigan		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	192	0	1	04	01	H5216_192_0	4	1				07/11/2018	2019.01	07/11/2018 12:42:30 PM Eastern Daylight Time	06/01/2018 01:31:22 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-192 (PPO)	01	04		1			H5216	192	0	2019	Select counties in Indiana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	193	0	1	04	01	H5216_193_0	3	1				07/06/2018	2019.01	07/06/2018 11:19:17 AM Eastern Daylight Time	06/01/2018 01:33:10 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-193 (PPO)	01	04		1			H5216	193	0	2019	Select counties in Indiana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	194	0	1	04	01	H5216_194_0	4	1				07/02/2018	2019.01	07/02/2018 12:46:50 PM Eastern Daylight Time	07/18/2018 02:10:06 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 09:52:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-194 (PPO)	01	04		1			H5216	194	0	2019	Washoe County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	195	0	1	04	01	H5216_195_0	5	1				07/11/2018	2019.01	07/11/2018 12:49:40 PM Eastern Daylight Time	06/01/2018 03:33:54 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-195 (PPO)	01	04		1			H5216	195	0	2019	Colorado		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	196	1	1	04	01	H5216_196_1	4	1				07/02/2018	2019.01	07/02/2018 04:45:21 PM Eastern Daylight Time	06/01/2018 03:19:57 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	01	04		1			H5216	196	1	2019	New Mexico	Greater New Mexico	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H5216	196	2	1	04	01	H5216_196_2	4	1				07/02/2018	2019.01	07/02/2018 04:46:36 PM Eastern Daylight Time	06/01/2018 03:30:20 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	01	04		1			H5216	196	2	2019	New Mexico	Southern New Mexico	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H5216	197	0	1	04	01	H5216_197_0	5	1				07/11/2018	2019.01	07/11/2018 03:21:39 PM Eastern Daylight Time	06/01/2018 03:22:10 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-197 (PPO)	01	04		1			H5216	197	0	2019	Select counties in Arizona		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	198	0	1	04	01	H5216_198_0	4	1				08/03/2018	2019.01	08/03/2018 04:18:47 PM Eastern Daylight Time	06/01/2018 03:22:51 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-198 (PPO)	01	04		1			H5216	198	0	2019	Coconino County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	199	0	1	04	01	H5216_199_0	5	1				07/11/2018	2019.01	07/11/2018 01:40:17 PM Eastern Daylight Time	06/01/2018 03:29:35 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 12:37:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-199 (PPO)	01	04		1			H5216	199	0	2019	Select counties in New Mexico		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	805	0	1	04	01	H5216_805_0	2	1				05/31/2018	2019.01	05/31/2018 11:21:50 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	805	0	2019	Select Counties in Multi-States		1	2209047	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	806	0	1	04	01	H5216_806_0	1	1				05/31/2018	2019.01	05/31/2018 11:31:37 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	806	0	2019	Select Counties in Multi-States		1	3148564	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	807	0	1	04	01	H5216_807_0	1	1				05/31/2018	2019.01	05/31/2018 11:41:18 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5216	807	0	2019	Select Counties in Multi-States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	808	0	2	04	01	H5216_808_0	1	1				05/31/2018	2019.01	05/31/2018 11:41:44 AM Eastern Daylight Time					05/31/2018 12:52:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5216	808	0	2019	Select Counties in Multi-States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	809	0	2	04	01	H5216_809_0	1	1				05/31/2018	2019.01	05/31/2018 11:43:03 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5216	809	0	2019	Select Counties in Multi-States		1	73656	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	810	0	2	04	01	H5216_810_0	1	1				05/31/2018	2019.01	05/31/2018 11:43:56 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5216	810	0	2019	Select Counties in Multi-States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5253	004	0	1	01	01	H5253_004_0	4	1				07/12/2018	2019.01	07/12/2018 12:35:27 PM Central Daylight Time	08/03/2018 09:59:20 AM Central Daylight Time	07/31/2018 07:19:20 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	004	0	2019	Milwaukee Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	007	0	1	02	01	H5253_007_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:58:54 PM Central Daylight Time	08/03/2018 10:00:06 AM Central Daylight Time	07/31/2018 07:19:44 PM Central Daylight Time			08/06/2018 12:26:46 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (HMO-POS SNP)	01	02		1			H5253	007	0	2019	Select Counties in Wisconsin		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	011	0	1	01	01	H5253_011_0	3	1				07/12/2018	2019.01	07/12/2018 12:35:58 PM Central Daylight Time	08/03/2018 10:00:48 AM Central Daylight Time	07/31/2018 07:20:08 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	011	0	2019	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	021	0	1	01	01	H5253_021_0	2	1				06/01/2018	2019.01	06/01/2018 02:08:28 PM Central Daylight Time	06/01/2018 04:44:00 PM Central Daylight Time				06/02/2018 11:59:05 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H5253	021	0	2019	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5253	024	0	1	01	01	H5253_024_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 05:53:19 PM Central Daylight Time	08/03/2018 10:02:12 AM Central Daylight Time	07/31/2018 07:20:32 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO SNP)	01	01		1			H5253	024	0	2019	Select counties in Wisconsin		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	030	0	1	01	01	H5253_030_0	3	1				07/12/2018	2019.01	07/12/2018 12:36:23 PM Central Daylight Time	08/03/2018 10:03:03 AM Central Daylight Time	07/31/2018 07:20:54 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	030	0	2019	Southern Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	033	0	1	01	01	H5253_033_0	3	1				08/02/2018	2019.01	08/02/2018 01:50:44 PM Central Daylight Time	08/03/2018 10:03:43 AM Central Daylight Time	07/31/2018 07:21:16 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Value (HMO)	01	01		1			H5253	033	0	2019	Milwaukee Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	034	0	1	01	01	H5253_034_0	3	1				08/02/2018	2019.01	08/02/2018 01:51:26 PM Central Daylight Time	08/03/2018 10:04:25 AM Central Daylight Time	07/31/2018 07:21:40 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Value (HMO)	01	01		1			H5253	034	0	2019	Select Counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	035	0	1	02	01	H5253_035_0	3	1				07/12/2018	2019.01	07/12/2018 12:31:04 PM Central Daylight Time	08/03/2018 10:05:08 AM Central Daylight Time	07/31/2018 07:22:02 PM Central Daylight Time			08/06/2018 09:40:13 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus (HMO-POS)	01	02		1			H5253	035	0	2019	Graham, Pima, and Santa Cruz counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	036	0	1	01	01	H5253_036_0	3	1				07/12/2018	2019.01	07/12/2018 12:32:04 PM Central Daylight Time	08/03/2018 10:05:50 AM Central Daylight Time	07/31/2018 07:22:26 PM Central Daylight Time			08/06/2018 09:40:13 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	036	0	2019	Yavapai county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	037	0	1	01	01	H5253_037_0	4	1				07/12/2018	2019.01	07/12/2018 01:32:37 PM Central Daylight Time	08/03/2018 10:06:33 AM Central Daylight Time	07/31/2018 07:22:48 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	037	0	2019	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;	
H5253	038	0	1	01	01	H5253_038_0	4	1				08/02/2018	2019.01	08/02/2018 02:50:46 PM Central Daylight Time	08/03/2018 10:07:17 AM Central Daylight Time	07/31/2018 07:23:12 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	038	0	2019	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;	
H5253	039	0	1	01	01	H5253_039_0	4	1				07/12/2018	2019.01	07/12/2018 12:46:48 PM Central Daylight Time	08/03/2018 10:07:59 AM Central Daylight Time	07/31/2018 07:23:34 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	039	0	2019	Durham and Wake counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	040	0	1	01	01	H5253_040_0	1	1				05/22/2018	2019.01	05/22/2018 07:40:54 PM Central Daylight Time	06/01/2018 04:38:40 PM Central Daylight Time				06/02/2018 11:43:32 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H5253	040	0	2019	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7a;7d;	
H5253	041	0	1	01	01	H5253_041_0	2	1	2	1		07/12/2018	2019.01	07/12/2018 01:13:04 PM Central Daylight Time	08/03/2018 10:09:27 AM Central Daylight Time	07/31/2018 07:24:00 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5253	041	0	2019	Select Counties in North Carolina		2		2			1	3		2		2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	042	0	1	01	01	H5253_042_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:58:40 PM Central Daylight Time	08/03/2018 10:10:09 AM Central Daylight Time	07/31/2018 07:24:24 PM Central Daylight Time			08/06/2018 12:26:46 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5253	042	0	2019	Select Counties in North Carolina		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	043	0	1	02	01	H5253_043_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:59:37 PM Central Daylight Time	08/03/2018 10:10:51 AM Central Daylight Time	07/31/2018 07:24:48 PM Central Daylight Time			08/06/2018 12:26:46 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS SNP)	01	02		1			H5253	043	0	2019	Select Counties in North Carolina		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	044	0	1	01	01	H5253_044_0	3	1				07/12/2018	2019.01	07/12/2018 12:37:55 PM Central Daylight Time	08/03/2018 10:11:34 AM Central Daylight Time	07/31/2018 07:25:10 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	044	0	2019	Select counties in Iowa		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	045	0	1	01	01	H5253_045_0	3	1				08/02/2018	2019.01	08/02/2018 01:51:51 PM Central Daylight Time	08/03/2018 10:12:18 AM Central Daylight Time	07/31/2018 07:25:32 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	045	0	2019	Select counties in Iowa		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	046	0	1	01	01	H5253_046_0	3	1				07/12/2018	2019.01	07/12/2018 11:46:51 AM Central Daylight Time	08/03/2018 10:13:00 AM Central Daylight Time	07/31/2018 07:25:56 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	046	0	2019	Northwestern Illinois		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	047	0	1	02	01	H5253_047_0	2	1				08/02/2018	2019.01	08/02/2018 12:59:36 PM Central Daylight Time	08/03/2018 10:13:43 AM Central Daylight Time	07/31/2018 07:26:20 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 1 (HMO-POS)	01	02		1			H5253	047	0	2019	Select Counties in Tennessee and Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	048	0	1	02	01	H5253_048_0	2	1				07/12/2018	2019.01	07/12/2018 11:21:33 AM Central Daylight Time	08/03/2018 10:14:28 AM Central Daylight Time	07/31/2018 07:26:42 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 2 (HMO-POS)	01	02		1			H5253	048	0	2019	Select Counties in Tennessee and Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	049	0	1	01	01	H5253_049_0	3	1				08/02/2018	2019.01	08/02/2018 02:10:53 PM Central Daylight Time	08/03/2018 10:15:11 AM Central Daylight Time	07/31/2018 07:27:04 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 7 (HMO)	01	01		1			H5253	049	0	2019	Cleveland Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	050	0	1	01	01	H5253_050_0	3	1				07/12/2018	2019.01	07/12/2018 11:48:44 AM Central Daylight Time	08/03/2018 10:15:54 AM Central Daylight Time	07/31/2018 07:27:28 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	050	0	2019	Cleveland Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	051	0	1	01	01	H5253_051_0	2	1				05/27/2018	2019.01	05/27/2018 08:55:44 AM Central Daylight Time	08/03/2018 10:16:37 AM Central Daylight Time	07/31/2018 07:27:50 PM Central Daylight Time			08/06/2018 09:06:49 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	051	0	2019	Cleveland Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	052	0	1	01	01	H5253_052_0	3	1				08/02/2018	2019.01	08/02/2018 02:11:13 PM Central Daylight Time	08/03/2018 10:17:20 AM Central Daylight Time	07/31/2018 07:28:14 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 6 (HMO)	01	01		1			H5253	052	0	2019	Cincinnati/Dayton Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	053	0	1	01	01	H5253_053_0	3	1				07/12/2018	2019.01	07/12/2018 11:50:33 AM Central Daylight Time	08/03/2018 10:18:02 AM Central Daylight Time	07/31/2018 07:28:36 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	053	0	2019	Select counties in Ohio and Kentucky		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	054	0	1	01	01	H5253_054_0	2	1				05/30/2018	2019.01	05/30/2018 03:14:57 PM Central Daylight Time	08/03/2018 10:18:43 AM Central Daylight Time	07/31/2018 07:29:00 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	054	0	2019	Cincinnati/Dayton Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	056	0	1	01	01	H5253_056_0	3	1				07/12/2018	2019.01	07/12/2018 11:50:58 AM Central Daylight Time	08/03/2018 10:19:26 AM Central Daylight Time	07/31/2018 07:29:22 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 4 (HMO)	01	01		1			H5253	056	0	2019	Lucas and Wood counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	057	0	1	01	01	H5253_057_0	3	1				08/02/2018	2019.01	08/02/2018 02:11:35 PM Central Daylight Time	08/03/2018 10:20:10 AM Central Daylight Time	07/31/2018 07:29:46 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 8 (HMO)	01	01		1			H5253	057	0	2019	Lucas and Wood counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	059	0	1	01	01	H5253_059_0	2	1	2	1		05/29/2018	2019.01	05/29/2018 03:26:50 PM Central Daylight Time	08/03/2018 10:20:50 AM Central Daylight Time	07/31/2018 07:30:10 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5253	059	0	2019	Select Counties in Ohio		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	060	0	1	02	01	H5253_060_0	4	1		1		08/10/2018	2019.01	08/10/2018 10:10:40 AM Central Daylight Time	08/10/2018 09:48:11 AM Central Daylight Time	07/31/2018 07:30:40 PM Central Daylight Time			08/10/2018 02:33:04 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5253	060	0	2019	Select Counties in Ohio		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	061	0	1	02	01	H5253_061_0	3	1		1		05/25/2018	2019.01	05/25/2018 09:19:25 AM Central Daylight Time	08/03/2018 10:22:11 AM Central Daylight Time	07/31/2018 07:31:02 PM Central Daylight Time			08/06/2018 12:26:46 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS SNP)	01	02		1			H5253	061	0	2019	Lake, Lorain, and Lucas Counties		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	062	0	1	01	01	H5253_062_0	3	1				08/02/2018	2019.01	08/02/2018 02:12:00 PM Central Daylight Time	08/03/2018 10:22:54 AM Central Daylight Time	07/31/2018 07:31:26 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 5 (HMO)	01	01		1			H5253	062	0	2019	Central Ohio area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	063	0	1	01	01	H5253_063_0	2	1				05/29/2018	2019.01	05/29/2018 02:51:06 PM Central Daylight Time	08/03/2018 10:23:33 AM Central Daylight Time	07/31/2018 07:31:48 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	063	0	2019	Central Ohio area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	064	0	1	02	01	H5253_064_0	2	1		1		05/24/2018	2019.01	05/24/2018 01:20:38 PM Central Daylight Time	08/03/2018 10:24:13 AM Central Daylight Time	07/31/2018 07:32:10 PM Central Daylight Time			08/06/2018 12:26:46 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS SNP)	01	02		1			H5253	064	0	2019	Select Counties in Wisconsin		2		2			1	1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	067	0	1	01	01	H5253_067_0	3	1				07/12/2018	2019.01	07/12/2018 11:52:26 AM Central Daylight Time	08/03/2018 10:24:53 AM Central Daylight Time	07/31/2018 07:32:34 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	067	0	2019	Lexington Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	068	0	1	01	01	H5253_068_0	2	1				05/29/2018	2019.01	05/29/2018 08:13:13 AM Central Daylight Time	08/03/2018 10:25:35 AM Central Daylight Time	07/31/2018 07:32:58 PM Central Daylight Time			08/06/2018 09:20:51 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	068	0	2019	Lexington Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	072	0	1	01	01	H5253_072_0	3	1				08/02/2018	2019.01	08/02/2018 01:52:51 PM Central Daylight Time	08/03/2018 10:26:17 AM Central Daylight Time	07/31/2018 07:33:20 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Value (HMO)	01	01		1			H5253	072	0	2019	Central Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	073	0	1	01	01	H5253_073_0	3	1				07/12/2018	2019.01	07/12/2018 12:39:20 PM Central Daylight Time	08/03/2018 10:27:01 AM Central Daylight Time	07/31/2018 07:33:44 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	073	0	2019	Central Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	074	0	1	01	01	H5253_074_0	3	1				07/12/2018	2019.01	07/12/2018 12:39:43 PM Central Daylight Time	08/03/2018 10:27:45 AM Central Daylight Time	07/31/2018 07:34:06 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Premier (HMO)	01	01		1			H5253	074	0	2019	Central Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	075	0	1	01	01	H5253_075_0	3	1				07/12/2018	2019.01	07/12/2018 12:40:05 PM Central Daylight Time	08/03/2018 10:28:31 AM Central Daylight Time	07/31/2018 07:34:30 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Premier (HMO)	01	01		1			H5253	075	0	2019	Milwaukee Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	076	0	1	01	01	H5253_076_0	3	1				07/12/2018	2019.01	07/12/2018 12:40:25 PM Central Daylight Time	08/03/2018 10:29:14 AM Central Daylight Time	07/31/2018 07:34:52 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Premier (HMO)	01	01		1			H5253	076	0	2019	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	077	0	1	01	01	H5253_077_0	3	1				07/12/2018	2019.01	07/12/2018 12:40:45 PM Central Daylight Time	08/03/2018 10:29:59 AM Central Daylight Time	07/31/2018 07:35:14 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Premier (HMO)	01	01		1			H5253	077	0	2019	Southern Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	079	0	1	01	01	H5253_079_0	4	1				08/02/2018	2019.01	08/02/2018 02:52:08 PM Central Daylight Time	08/03/2018 10:30:39 AM Central Daylight Time	07/31/2018 07:35:38 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	079	0	2019	Asheville Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;	
H5253	080	0	1	01	01	H5253_080_0	5	1				07/12/2018	2019.01	07/12/2018 12:49:51 PM Central Daylight Time	08/03/2018 10:31:19 AM Central Daylight Time	07/31/2018 07:36:00 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	080	0	2019	Asheville Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;	
H5253	081	0	1	01	01	H5253_081_0	3	1				07/12/2018	2019.01	07/12/2018 06:39:21 PM Central Daylight Time	08/03/2018 10:31:59 AM Central Daylight Time	07/31/2018 07:36:22 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	081	0	2019	Memphis Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	082	0	1	01	01	H5253_082_0	3	1				07/12/2018	2019.01	07/12/2018 06:39:46 PM Central Daylight Time	08/03/2018 10:32:38 AM Central Daylight Time	07/31/2018 07:36:46 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	082	0	2019	Memphis Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	083	0	1	01	01	H5253_083_0	3	1				08/02/2018	2019.01	08/02/2018 01:02:32 PM Central Daylight Time	08/03/2018 10:33:19 AM Central Daylight Time	07/31/2018 07:37:08 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	083	0	2019	Nashville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	084	0	1	01	01	H5253_084_0	3	1				07/12/2018	2019.01	07/12/2018 06:40:20 PM Central Daylight Time	08/03/2018 10:33:59 AM Central Daylight Time	07/31/2018 07:37:32 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	084	0	2019	Nashville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	085	0	1	01	01	H5253_085_0	4	1				08/02/2018	2019.01	08/02/2018 02:28:57 PM Central Daylight Time	08/03/2018 10:34:41 AM Central Daylight Time	07/31/2018 07:37:54 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	085	0	2019	Select counties in Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	086	0	1	01	01	H5253_086_0	4	1				07/12/2018	2019.01	07/12/2018 01:11:23 PM Central Daylight Time	08/03/2018 10:35:25 AM Central Daylight Time	07/31/2018 07:38:18 PM Central Daylight Time			08/06/2018 01:15:48 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	086	0	2019	Select counties in Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	087	0	1	01	01	H5253_087_0	4	1				08/02/2018	2019.01	08/02/2018 02:33:07 PM Central Daylight Time	08/03/2018 10:36:09 AM Central Daylight Time	07/31/2018 07:38:42 PM Central Daylight Time			08/06/2018 01:26:31 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	087	0	2019	Southeastern Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	088	0	1	01	01	H5253_088_0	4	1				07/12/2018	2019.01	07/12/2018 01:11:57 PM Central Daylight Time	08/03/2018 10:36:51 AM Central Daylight Time	07/31/2018 07:39:04 PM Central Daylight Time			08/06/2018 01:26:31 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	088	0	2019	Southeastern Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	089	0	1	01	01	H5253_089_0	4	1				07/12/2018	2019.01	07/12/2018 01:10:46 PM Central Daylight Time	08/03/2018 10:37:31 AM Central Daylight Time	07/31/2018 07:39:26 PM Central Daylight Time			08/06/2018 01:26:31 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	089	0	2019	Northern VA and Washington DC Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	090	0	1	01	01	H5253_090_0	3	1				05/29/2018	2019.01	05/29/2018 02:58:48 PM Central Daylight Time	08/03/2018 10:38:12 AM Central Daylight Time	07/31/2018 07:39:50 PM Central Daylight Time			08/06/2018 01:26:31 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	090	0	2019	Northern VA and Washington DC Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	091	0	1	01	01	H5253_091_0	4	1				08/02/2018	2019.01	08/02/2018 02:12:24 PM Central Daylight Time	08/03/2018 10:38:55 AM Central Daylight Time	07/31/2018 07:40:12 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	091	0	2019	Lexington Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	097	0	1	01	01	H5253_097_0	4	1				08/02/2018	2019.01	08/02/2018 01:53:27 PM Central Daylight Time	08/03/2018 10:39:40 AM Central Daylight Time	07/31/2018 07:40:36 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Value (HMO)	01	01		1			H5253	097	0	2019	Southern Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	099	0	1	01	01	H5253_099_0	4	1				08/02/2018	2019.01	08/02/2018 02:12:39 PM Central Daylight Time	08/03/2018 10:40:28 AM Central Daylight Time	07/31/2018 07:40:58 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	099	0	2019	Louisville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	100	0	1	01	01	H5253_100_0	4	1				07/12/2018	2019.01	07/12/2018 11:54:20 AM Central Daylight Time	08/03/2018 10:41:12 AM Central Daylight Time	07/31/2018 07:41:22 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	100	0	2019	Louisville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	102	0	1	01	01	H5253_102_0	7	1				07/12/2018	2019.01	07/12/2018 12:50:15 PM Central Daylight Time	08/03/2018 10:41:53 AM Central Daylight Time	07/31/2018 07:41:44 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	102	0	2019	Durham and Wake Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	103	0	1	01	01	H5253_103_0	5	1				07/12/2018	2019.01	07/12/2018 12:50:44 PM Central Daylight Time	08/03/2018 10:42:35 AM Central Daylight Time	07/31/2018 07:42:06 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	103	0	2019	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	104	0	1	01	01	H5253_104_0	6	1				07/12/2018	2019.01	07/12/2018 12:51:10 PM Central Daylight Time	08/03/2018 10:43:19 AM Central Daylight Time	07/31/2018 07:42:30 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	104	0	2019	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	105	0	1	01	01	H5253_105_0	6	1				08/02/2018	2019.01	08/02/2018 02:53:38 PM Central Daylight Time	08/03/2018 10:44:02 AM Central Daylight Time	07/31/2018 07:42:52 PM Central Daylight Time			08/06/2018 09:23:01 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	105	0	2019	Buncombe, McDowell, and Transylvania counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;	
H5253	801	0	1	01	01	H5253_801_0	2	1				06/02/2018	2019.01	06/02/2018 02:08:55 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	801	0	2019	Milwaukee and Green Bay Area Counties		1	300	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	802	0	1	01	01	H5253_802_0	2	1				05/25/2018	2019.01	05/25/2018 04:27:15 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	802	0	2019	Milwaukee and Green Bay Area Counties		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H5253	805	0	1	01	01	H5253_805_0	2	1				05/25/2018	2019.01	05/25/2018 04:27:43 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	805	0	2019	Select Counties in WI		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	810	0	1	01	01	H5253_810_0	2	1				05/25/2018	2019.01	05/25/2018 04:28:12 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	810	0	2019	Arizona		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	811	0	1	01	01	H5253_811_0	2	1				05/25/2018	2019.01	05/25/2018 04:28:40 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	811	0	2019	Arizona		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	812	0	1	01	01	H5253_812_0	2	1				05/25/2018	2019.01	05/25/2018 04:29:05 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	812	0	2019	Arizona		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H5253	813	0	1	01	01	H5253_813_0	2	1				05/25/2018	2019.01	05/25/2018 04:29:38 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	813	0	2019	Select counties in North Carolina		1	4764	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	814	0	1	01	01	H5253_814_0	2	1				05/25/2018	2019.01	05/25/2018 04:30:24 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	814	0	2019	Select counties in North Carolina		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	815	0	1	01	01	H5253_815_0	2	1				05/25/2018	2019.01	05/25/2018 04:31:00 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	815	0	2019	Select counties in North Carolina		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H5253	816	0	2	01	01	H5253_816_0	2	1				05/25/2018	2019.01	05/25/2018 04:31:31 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	816	0	2019	Select counties in North Carolina		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	817	0	2	01	01	H5253_817_0	2	1				05/25/2018	2019.01	05/25/2018 04:31:55 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	817	0	2019	Select counties in North Carolina		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	818	0	1	01	01	H5253_818_0	2	1				05/25/2018	2019.01	05/25/2018 04:32:25 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	818	0	2019	Select counties in IA, IL, TN, & VA		1	3912	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	819	0	1	01	01	H5253_819_0	2	1				05/25/2018	2019.01	05/25/2018 04:32:56 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	819	0	2019	Select counties in IA, IL, TN, & VA		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H5253	820	0	1	01	01	H5253_820_0	2	1				05/25/2018	2019.01	05/25/2018 04:34:03 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	820	0	2019	Select counties in IA, IL, TN, & VA		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	821	0	1	01	01	H5253_821_0	2	1				05/25/2018	2019.01	05/25/2018 04:34:41 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	821	0	2019	Select counties in Kentucky and Ohio		1	888	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5253	822	0	1	01	01	H5253_822_0	2	1				05/25/2018	2019.01	05/25/2018 04:35:07 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	822	0	2019	Select counties in Kentucky and Ohio		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H5253	823	0	1	01	01	H5253_823_0	2	1				05/25/2018	2019.01	05/25/2018 04:35:57 PM Central Daylight Time					06/02/2018 02:10:58 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	823	0	2019	Select counties in Kentucky and Ohio		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H5256	001	0	1	18	06	H5256_001_0	1	2				06/01/2018	2019.01	06/01/2018 10:03:11 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H5256	001	0	2019	Grant, Crawford, Iowa, Lafayette Counties		2	34027	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H5256	002	0	1	18	06	H5256_002_0	1	2				06/01/2018	2019.01	06/01/2018 10:03:21 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H5256	002	0	2019	Grant, Crawford, Iowa, Lafayette Counties		2	4516	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H5256	004	0	1	18	06	H5256_004_0	1	2				06/01/2018	2019.01	06/01/2018 10:07:10 AM Central Daylight Time					06/01/2018 10:07:44 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H5256	004	0	2019	Grant, Crawford, Iowa, Lafayette Counties		2	4687	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H5262	001	0	1	01	01	H5262_001_0	3	1				07/18/2018	2019.01	07/18/2018 01:59:32 PM Central Daylight Time	06/02/2018 12:03:12 PM Central Daylight Time	06/02/2018 12:01:42 PM Central Daylight Time			07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H5262	001	0	2019	La Crosse and SW Wisconsin and NE Iowa		2	64584	2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	003	0	1	01	01	H5262_003_0	3	1				07/18/2018	2019.01	07/18/2018 02:01:02 PM Central Daylight Time	06/02/2018 12:03:11 PM Central Daylight Time	06/02/2018 12:02:02 PM Central Daylight Time			07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Value (w/Rx) (HMO)	01	01		1			H5262	003	0	2019	La Crosse and SW Wisconsin and NE Iowa		2	67195	2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	004	0	1	01	01	H5262_004_0	3	1				07/18/2018	2019.01	07/18/2018 02:01:16 PM Central Daylight Time	06/02/2018 12:03:10 PM Central Daylight Time				07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Value (no Rx) (HMO)	01	01		1			H5262	004	0	2019	La Crosse and SW Wisconsin and NE Iowa		2	23106	2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	005	0	1	01	01	H5262_005_0	3	1				07/18/2018	2019.01	07/18/2018 02:01:30 PM Central Daylight Time	06/02/2018 12:03:09 PM Central Daylight Time				07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Elite (no Rx) (HMO)	01	01		1			H5262	005	0	2019	La Crosse and SW Wisconsin and NE Iowa		2	20003	2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	007	0	1	01	01	H5262_007_0	1	1				06/01/2018	2019.01	06/01/2018 05:14:39 PM Central Daylight Time	06/02/2018 12:03:07 PM Central Daylight Time	06/02/2018 12:02:01 PM Central Daylight Time			06/02/2018 12:09:12 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H5262	007	0	2019	Columbia, Dane, Iowa, Richland, and Sauk Counties		2	11969	2			2						https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	008	0	1	01	01	H5262_008_0	1	1				06/01/2018	2019.01	06/01/2018 05:15:04 PM Central Daylight Time	06/02/2018 12:03:06 PM Central Daylight Time	06/02/2018 12:02:00 PM Central Daylight Time			06/02/2018 12:09:12 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Value (w/Rx) (HMO)	01	01		1			H5262	008	0	2019	Columbia, Dane, Iowa, Richland, and Sauk Counties		2	6307	2			2						https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	009	0	1	01	01	H5262_009_0	1	1				05/31/2018	2019.01	05/31/2018 10:57:38 AM Central Daylight Time	06/02/2018 12:03:04 PM Central Daylight Time				06/02/2018 12:09:12 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Value (no Rx) (HMO)	01	01		1			H5262	009	0	2019	Columbia, Dane, Iowa, Richland, and Sauk Counties		2	2418	2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	010	0	1	01	01	H5262_010_0	1	1				05/31/2018	2019.01	05/31/2018 10:59:49 AM Central Daylight Time	06/02/2018 12:03:03 PM Central Daylight Time				06/02/2018 12:09:12 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Elite (no Rx) (HMO)	01	01		1			H5262	010	0	2019	Columbia, Dane, Iowa, Richland, and Sauk Counties		2	2466	2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	011	0	1	01	01	H5262_011_0	1	1				06/01/2018	2019.01	06/01/2018 05:15:32 PM Central Daylight Time	06/02/2018 12:02:46 PM Central Daylight Time	06/02/2018 12:01:57 PM Central Daylight Time			06/02/2018 12:09:12 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	ProHealth Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H5262	011	0	2019	Waukesha County		2	3263	2			2						https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredprohealth/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	012	0	1	01	01	H5262_012_0	2	1				06/01/2018	2019.01	06/01/2018 05:16:22 PM Central Daylight Time	08/07/2018 12:25:14 PM Central Daylight Time	08/07/2018 12:24:35 PM Central Daylight Time			08/07/2018 01:02:16 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	ProHealth Senior Preferred Value (w/Rx) (HMO)	01	01		1			H5262	012	0	2019	Waukesha County		2	728	2			2						https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredprohealth/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	013	0	1	01	01	H5262_013_0	1	1				05/31/2018	2019.01	05/31/2018 12:02:15 PM Central Daylight Time	06/02/2018 12:02:40 PM Central Daylight Time				06/02/2018 12:09:12 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	ProHealth Senior Preferred Elite (no Rx) (HMO)	01	01		1			H5262	013	0	2019	Waukesha County		2	323	2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredprohealth/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	018	0	1	01	01	H5262_018_0	3	1				07/18/2018	2019.01	07/18/2018 02:02:14 PM Central Daylight Time	06/02/2018 12:03:01 PM Central Daylight Time	06/02/2018 12:01:55 PM Central Daylight Time			07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	seniorpreferred.org/seniorpreferredswedishamerican	SwedishAmerican Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H5262	018	0	2019	Winnebago County		2	1770	2			2						https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredswedishamerican/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	019	0	1	01	01	H5262_019_0	4	1				07/18/2018	2019.01	07/18/2018 02:02:29 PM Central Daylight Time	08/07/2018 12:24:18 PM Central Daylight Time	08/07/2018 12:24:27 PM Central Daylight Time			08/07/2018 01:02:16 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	seniorpreferred.org/seniorpreferredswedishamerican	SwedishAmerican Senior Preferred Value (w/Rx) (HMO)	01	01		1			H5262	019	0	2019	Winnebago County		2	1323	2			2						https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredswedishamerican/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	020	0	1	01	01	H5262_020_0	4	1				07/18/2018	2019.01	07/18/2018 02:02:45 PM Central Daylight Time	06/02/2018 12:03:00 PM Central Daylight Time				07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	seniorpreferred.org/seniorpreferredswedishamerican	SwedishAmerican Senior Preferred Elite (no Rx) (HMO)	01	01		1			H5262	020	0	2019	Winnebago County		2	416	2			2						https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredswedishamerican/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	801	0	1	01	01	H5262_801_0	2	1				06/02/2018	2019.01	06/02/2018 01:34:21 PM Central Daylight Time					06/02/2018 01:34:48 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	Employer Group Senior Preferred (w/ Rx) (HMO)	01	01		1			H5262	801	0	2019	Southern and Western Wisconsin, Winnebago CTY, IL		1	1200	2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	http://www.seniorpreferred.org/	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		1	1	2;5;6;7c;7d;11a;11b;15;	2		1					1				
H5262	802	0	1	01	01	H5262_802_0	2	1				06/02/2018	2019.01	06/02/2018 01:34:35 PM Central Daylight Time					06/02/2018 01:34:48 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Senior Preferred	www.seniorpreferred.org	Employer Group Senior Preferred (no Rx) (HMO)	01	01		1			H5262	802	0	2019	Southern and Western Wisconsin, Winnebago CTY, IL		1	1200	2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	http://www.seniorpreferred.org/	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										1	1	2;5;6;7c;7d;11a;11b;15;	2		1					1				
H5264	002	0	1	18	06	H5264_002_0	3	2				07/16/2018	2019.01	07/16/2018 09:50:21 AM Central Daylight Time					07/16/2018 09:56:24 AM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Enhanced (Cost)	06	18		1			H5264	002	0	2019	South Central Wisconsin		2	208886	2			2								www.deancare.com/find-a-doctor	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5264	003	0	1	18	06	H5264_003_0	3	2				07/16/2018	2019.01	07/16/2018 09:50:36 AM Central Daylight Time					07/16/2018 09:56:24 AM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Basic (Cost)	06	18		1			H5264	003	0	2019	South Central Wisconsin		2	1203	2			2								www.deancare.com/find-a-doctor	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5264	005	0	1	18	06	H5264_005_0	3	2				07/16/2018	2019.01	07/16/2018 09:50:50 AM Central Daylight Time					07/16/2018 09:56:24 AM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Shared Value (Cost)	06	18		1			H5264	005	0	2019	South Central Wisconsin		2	44628	2			2								www.deancare.com/drugformulary	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5273	001	0	1	01	01	H5273_001_0	6	1				06/01/2018	2019.01	06/01/2018 01:23:24 PM Eastern Daylight Time	08/02/2018 09:14:10 AM Eastern Daylight Time	08/02/2018 09:10:52 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CareAdvantage Preferred (HMO)	01	01		1			H5273	001	0	2019	Most of Connecticut		2		2			2						www.carepartnersct.com/doctor-search	www.carepartnersct.com/drug-search	www.carepartnersct.com/doctor-search	(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5273	002	0	1	01	01	H5273_002_0	6	1				06/01/2018	2019.01	06/01/2018 12:08:02 PM Eastern Daylight Time	08/02/2018 09:16:58 AM Eastern Daylight Time	08/02/2018 09:11:42 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CareAdvantage Prime (HMO)	01	01		1			H5273	002	0	2019	Most of Connecticut		2		2			2						www.carepartnersct.com/doctor-search	www.carepartnersct.com/drug-search	www.carepartnersct.com/doctor-search	(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5273	003	0	1	01	01	H5273_003_0	6	1				06/01/2018	2019.01	06/01/2018 12:08:26 PM Eastern Daylight Time	08/02/2018 09:18:46 AM Eastern Daylight Time	08/02/2018 09:12:40 AM Eastern Daylight Time			08/06/2018 02:30:09 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CareAdvantage Premier (HMO)	01	01		1			H5273	003	0	2019	Most of Connecticut		2		2			2						www.carepartnersct.com/doctor-search	www.carepartnersct.com/drug-search	www.carepartnersct.com/doctor-search	(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5280	001	0	1	48	05	H5280_001_0	3	1				08/21/2018	2019.01	08/21/2018 10:10:59 AM Pacific Daylight Time					08/21/2018 02:01:44 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/duals	Molina Dual Options  MyCareOhio (Medicare-Medicaid Plan)	05	48		1			H5280	001	0	2019	Ohio		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4623		(855)665-4623		(866)856-8295		(866)856-8295		(855)665-4623		(855)665-4623		(866)856-8295		(866)856-8295		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H5294	002	1	1	01	01	H5294_002_1	5	1	2	1		08/03/2018	2019.01	08/03/2018 06:36:08 PM Eastern Daylight Time	08/03/2018 07:22:26 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:13:37 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5294	002	1	2019	Bex, Coll, Cam, Dall, Hidalgo, Nueces, Rock, Tarr	Collin, Rockwall	2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	002	2	1	01	01	H5294_002_2	5	1	2	1		08/01/2018	2019.01	08/01/2018 01:40:58 PM Eastern Daylight Time	08/03/2018 07:22:27 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:13:37 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5294	002	2	2019	Bex, Coll, Cam, Dall, Hidalgo, Nueces, Rock, Tarr	Cameron, Hidalgo	2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	002	3	1	01	01	H5294_002_3	5	1	2	1		08/01/2018	2019.01	08/01/2018 01:42:03 PM Eastern Daylight Time	08/03/2018 07:22:27 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:13:37 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5294	002	3	2019	BX, CAM, COL, DL, EP, FB, GU, HG, NU, RW, SM, TR	Dallas Metro and Tyler Area	2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	002	4	1	01	01	H5294_002_4	5	1	2	1		08/01/2018	2019.01	08/01/2018 01:42:27 PM Eastern Daylight Time	08/03/2018 07:22:27 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:13:37 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5294	002	4	2019	BX, CAM, COL, DL, EP, FB, GU, HG, NU, RW, SM, TR	San Antonio Metro and Corpus Christi Area	2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	006	0	1	01	01	H5294_006_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 09:56:43 AM Eastern Daylight Time	08/03/2018 07:22:27 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:13:37 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5294	006	0	2019	El Paso		2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/find-doctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	007	0	1	01	01	H5294_007_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 01:56:48 PM Eastern Daylight Time	08/03/2018 07:22:27 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:13:37 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5294	007	0	2019	Suburban Houston		2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	008	0	1	01	01	H5294_008_0	5	1	2	1		08/01/2018	2019.01	08/01/2018 01:44:45 PM Eastern Daylight Time	08/03/2018 07:22:17 PM Eastern Daylight Time	08/03/2018 07:51:47 PM Eastern Daylight Time			08/03/2018 09:13:37 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5294	008	0	2019	North Austin		2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/find-doctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	011	0	1	01	01	H5302_011_0	3	1				05/17/2018	2019.01	05/17/2018 09:49:13 AM Eastern Daylight Time	08/02/2018 03:37:26 PM Eastern Daylight Time	07/31/2018 11:11:58 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (GA)	AETNA HEALTH INC. (GA)	www.coventry-medicare.com	Advantra Platinum (HMO)	01	01		1			H5302	011	0	2019	Select Georgia Counties		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(866)613-4977		(866)613-4977		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	012	0	1	01	01	H5302_012_0	3	1	2	1		08/01/2018	2019.01	08/01/2018 04:42:56 PM Eastern Daylight Time	08/02/2018 03:40:25 PM Eastern Daylight Time	07/31/2018 11:12:50 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA HEALTH INC. (GA)	AETNA HEALTH INC. (GA)	www.aetnamedicare.com	Aetna Medicare Dual Preferred (HMO SNP)	01	01		1			H5302	012	0	2019	Atlanta Metro		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	809	0	1	01	01	H5302_809_0	3	1				06/04/2018	2019.01	06/04/2018 12:01:24 PM Eastern Daylight Time					06/04/2018 12:11:45 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Coventry Health Care	http://ga.chcadvantra.com	Advantra (HMO)	01	01		1			H5302	809	0	2019	Georgia		1	120	2			2						http//Pharmacylocator.Coventry-Medicare.com	http//GAformulary.Coventry-Medicare.com	http://www.ProviderDirectory.coventry-medicare.com	(866)613-4977		(866)613-4977		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H5302	810	0	1	01	01	H5302_810_0	3	1				06/04/2018	2019.01	06/04/2018 12:01:08 PM Eastern Daylight Time					06/04/2018 12:11:45 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Coventry Health Care	http://ga.chcadvantra.com	Advantra (HMO)	01	01		1			H5302	810	0	2019	Georgia		1	120	2			2						http//Pharmacylocator.coventry-Medicare.com	http//GAformulary.Coventry-Medicare.com	http://www.ProviderDirectory.coventry-medicare.com	(866)613-4977		(866)613-4977		(855)338-7027		(855)338-7027		(844)741-8423		(844)741-8423		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					2				
H5322	001	0	1	02	01	H5322_001_0	2	1		1		08/02/2018	2019.01	08/02/2018 03:00:56 PM Central Daylight Time	08/03/2018 09:50:41 AM Central Daylight Time	07/31/2018 07:43:18 PM Central Daylight Time			08/06/2018 12:30:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	001	0	2019	Select Counties in OH, SC and VA		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	003	0	1	01	01	H5322_003_0	2	1		1		08/02/2018	2019.01	08/02/2018 03:01:18 PM Central Daylight Time	08/03/2018 09:51:17 AM Central Daylight Time	07/31/2018 07:43:42 PM Central Daylight Time			08/06/2018 12:30:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5322	003	0	2019	Select Counties in FL and NJ		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	004	0	1	02	01	H5322_004_0	2	1		1		08/02/2018	2019.01	08/02/2018 03:01:38 PM Central Daylight Time	08/03/2018 09:51:52 AM Central Daylight Time	07/31/2018 07:44:06 PM Central Daylight Time			08/06/2018 12:30:54 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	004	0	2019	Atlanta and Augusta Metro areas		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	024	0	1	01	01	H5322_024_0	2	1				05/25/2018	2019.01	05/25/2018 09:54:08 AM Central Daylight Time	08/03/2018 09:52:27 AM Central Daylight Time	07/31/2018 07:44:30 PM Central Daylight Time			08/06/2018 01:26:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5322	024	0	2019	Grafton, Hillsborough, and Rockingham Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	025	0	1	01	01	H5322_025_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 02:00:37 PM Central Daylight Time	08/03/2018 09:53:04 AM Central Daylight Time	07/31/2018 07:44:54 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5322	025	0	2019	Select Counties in Texas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	026	0	1	01	01	H5322_026_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 12:49:38 PM Central Daylight Time	08/03/2018 09:53:40 AM Central Daylight Time	07/31/2018 07:45:20 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5322	026	0	2019	Cameron, Hidalgo, and Willacy Counties		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	028	0	1	02	01	H5322_028_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 12:49:42 PM Central Daylight Time	08/03/2018 09:54:18 AM Central Daylight Time	07/31/2018 07:45:44 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS SNP)	01	02		1			H5322	028	0	2019	Select Counties in Ohio		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	029	0	1	02	01	H5322_029_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 12:49:48 PM Central Daylight Time	08/03/2018 09:54:55 AM Central Daylight Time	07/31/2018 07:46:08 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS SNP)	01	02		1			H5322	029	0	2019	Select Counties in Kansas		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)262-9947		(866)262-9947		(888)834-3721		(888)834-3721		(866)262-9947		(866)262-9947		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	030	0	1	02	01	H5322_030_0	2	1	2	1		05/31/2018	2019.01	05/31/2018 03:55:50 PM Central Daylight Time	08/03/2018 09:55:31 AM Central Daylight Time	07/31/2018 07:46:34 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS SNP)	01	02		1			H5322	030	0	2019	Select Counties in Georgia		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	031	0	1	01	01	H5322_031_0	3	1	2	1		05/31/2018	2019.01	05/31/2018 03:59:44 PM Central Daylight Time	08/03/2018 09:56:06 AM Central Daylight Time	07/31/2018 07:46:58 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5322	031	0	2019	Select Counites in OK		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7150		(844)368-7150		(888)834-3721		(888)834-3721		(844)368-7150		(844)368-7150		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	001	0	1	01	01	H5325_001_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 06:01:12 PM Central Daylight Time	08/03/2018 07:33:46 AM Central Daylight Time	08/05/2018 12:41:34 PM Central Daylight Time			08/05/2018 01:23:00 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	www.coventry-medicare.com	Medicare Dual Preferred Plus (HMO SNP)	01	01		1			H5325	001	0	2019	Johnson		2		2			1	3		1		1	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	002	0	1	01	01	H5325_002_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 06:01:26 PM Central Daylight Time	08/03/2018 07:35:12 AM Central Daylight Time	08/05/2018 12:40:18 PM Central Daylight Time			08/05/2018 01:23:00 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	www.coventry-medicare.com	Medicare Dual Preferred Plus (HMO SNP)	01	01		1			H5325	002	0	2019	Sedgwick		2		2			1	3		1		1	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	003	0	1	01	01	H5325_003_0	3	1	2	1		05/26/2018	2019.01	05/26/2018 11:30:29 AM Pacific Daylight Time	08/03/2018 07:36:16 AM Central Daylight Time	08/05/2018 12:38:26 PM Central Daylight Time			08/05/2018 01:23:00 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	www.coventry-medicare.com	Medicare Dual Core (HMO SNP)	01	01		1			H5325	003	0	2019	Cass Jackson		2		2			1	3		1		1	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	004	0	1	01	01	H5325_004_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 06:01:45 PM Central Daylight Time	08/03/2018 07:37:25 AM Central Daylight Time	08/05/2018 12:37:14 PM Central Daylight Time			08/05/2018 01:23:00 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	www.coventry-medicare.com	Medicare Dual Core (HMO SNP)	01	01		1			H5325	004	0	2019	Christian Greene		2		2			1	3		1		1	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	005	0	1	01	01	H5325_005_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 06:01:55 PM Central Daylight Time	08/02/2018 01:37:06 PM Central Daylight Time	08/05/2018 12:35:10 PM Central Daylight Time			08/05/2018 01:23:00 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	www.coventry-medicare.com	Gold Dual Core (HMO SNP)	01	01		1			H5325	005	0	2019	Missouri		2		2			1	3		1		1	www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(833)620-8808		(833)620-8808		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5337	001	0	1	01	01	H5337_001_0	3	1	2	1		08/03/2018	2019.01	08/03/2018 07:23:45 AM Eastern Daylight Time	08/02/2018 03:03:42 PM Eastern Daylight Time	07/31/2018 11:42:08 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (OH)	Aetna Better Health of Ohio (HMO SNP)	www.aetnabetterhealth.com/ohio-hmosnp	Aetna Better Health of Ohio Dual Preferred (HMO SNP)	01	01		1			H5337	001	0	2019	NE/NW Ohio		2		2			1	3		2		2	www.aetnabetterhealth.com/ohio-hmosnp	www.aetnabetterhealth.com/ohio-hmosnp	www.aetnabetterhealth.com/ohio-hmosnp	(800)282-5366		(800)260-3166		(855)338-7027		(800)260-3166		(800)282-5366		(800)282-5366		(855)338-7027		(800)260-3166		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5355	001	0	1	48	05	H5355_001_0	3	1				07/19/2018	2019.01	07/19/2018 05:23:54 PM Pacific Daylight Time					07/19/2018 05:24:07 PM Pacific Daylight Time	IEHP HEALTH ACCESS	IEHP DualChoice	www.iehp.org	IEHP DualChoice (Medicare-Medicaid Plan)	05	48		1			H5355	001	0	2019	Riverside and San Bernardino Counties		2	320126	2			2						www.iehp.org	www.iehp.org	www.iehp.org	(877)273-4347		(877)273-4347		(800)741-4347		(800)741-4347		(877)273-4347		(877)273-4347		(800)741-4347		(800)741-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347																
H5377	001	0	1	01	01	H5377_001_0	4	1				07/03/2018	2019.01	07/03/2018 10:30:23 AM Eastern Daylight Time	08/03/2018 09:57:16 AM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 10:14:45 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5377-001 (HMO)	01	01		1			H5377	001	0	2019	Roanoke Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5386	003	0	1	01	01	H5386_003_0	3	1				05/31/2018	2019.01	05/31/2018 05:26:40 PM Pacific Daylight Time	08/02/2018 09:26:44 AM Pacific Daylight Time	08/02/2018 09:20:47 AM Pacific Daylight Time			08/03/2018 12:26:56 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Gold Card (HMO)	01	01		1			H5386	003	0	2019	Sharp Direct Advantage Gold San Diego County		2	10034	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5386	004	0	1	01	01	H5386_004_0	3	1				05/31/2018	2019.01	05/31/2018 05:26:53 PM Pacific Daylight Time	08/02/2018 09:23:48 AM Pacific Daylight Time	08/02/2018 09:30:59 AM Pacific Daylight Time			08/03/2018 12:26:56 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Platinum Card (HMO)	01	01		1			H5386	004	0	2019	Sharp Direct Advantage Platinum San Diego County		2	4300	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5386	801	0	1	01	01	H5386_801_0	1	1				06/01/2018	2019.01	06/01/2018 02:44:10 PM Pacific Daylight Time					06/01/2018 02:46:37 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Calendar Year (HMO)	01	01		1			H5386	801	0	2019	Sharp Direct Advantage San Diego County		1	5100	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;9b;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;12;14d;14e2;16b;17a;18a;	1					1				
H5386	802	0	1	01	01	H5386_802_0	1	1				06/01/2018	2019.01	06/01/2018 02:44:28 PM Pacific Daylight Time					06/01/2018 02:46:37 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Non-Calendar Year (HMO)	01	01		1			H5386	802	0	2019	Sharp Direct Advantage San Diego County		1	4800	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;9b;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9d;12;14d;14e2;16b;17a;18a;	1					1				
H5386	803	0	1	01	01	H5386_803_0	1	1				06/01/2018	2019.01	06/01/2018 02:45:14 PM Pacific Daylight Time					06/01/2018 02:46:37 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage MA Only (HMO)	01	01		1			H5386	803	0	2019	Sharp Direct Advantage San Diego County		1	0	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050										(711)-		(711)-		(711)-		(711)-										1	2		2		1					2				
H5403	001	0	1	20	08	H5403_001_0	1	1				05/31/2018	2019.01	05/31/2018 12:00:04 PM Pacific Daylight Time		05/31/2018 11:47:27 AM Pacific Daylight Time			05/31/2018 12:02:28 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onloklifeways.org	On Lok Lifeways (Dual Eligibles) (PACE)	08	20		1			H5403	001	0	2019	San Francisco, Alameda and Santa Clara counties		2		2			2						www.onloklifeways.org	N/A										(888)996-6565		(415)292-8895		(888)886-6565		(888)886-6565										(888)996-6565		(415)292-8898		(888)886-6565		(415)292-8898																
H5403	002	0	1	20	08	H5403_002_0	1	1				05/31/2018	2019.01	05/31/2018 12:00:59 PM Pacific Daylight Time		05/31/2018 11:47:20 AM Pacific Daylight Time			05/31/2018 12:02:28 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onloklifeways.org	On Lok Lifeways (Medicare Only) (PACE)	08	20		1			H5403	002	0	2019	San Francisco, Alameda and Santa Clara counties		2		2			2						www.onloklifeways.org	N/A										(888)996-6565		(415)292-8895		(888)886-6565		(888)886-6565										(888)996-6565		(415)292-8898		(888)886-6565		(415)292-8898																
H5405	001	0	1	20	08	H5405_001_0	1	1				05/23/2018	2019.01	05/23/2018 10:09:36 AM Pacific Daylight Time		05/22/2018 01:58:22 PM Pacific Daylight Time			05/23/2018 10:15:45 AM Pacific Daylight Time	CENTER FOR ELDERS INDEPENDENCE	Center For Elders' Independence	www.cei.elders.org	Center for Elders' Independence - Part D (PACE)	08	20		1			H5405	001	0	2019	Alameda and West Contra Costa Counties		2		2			2						www.cei.elders.org	www.cei.elders.org										(510)433-1150		(510)433-1150		(510)433-1150		(510)433-1150										(510)433-1165		(510)433-1165		(510)433-1165		(510)433-1165																
H5405	002	0	1	20	08	H5405_002_0	1	1				05/23/2018	2019.01	05/23/2018 10:11:31 AM Pacific Daylight Time		05/22/2018 01:59:08 PM Pacific Daylight Time			05/23/2018 10:15:45 AM Pacific Daylight Time	CENTER FOR ELDERS INDEPENDENCE	Center For Elders' Independence	www.cei.elders.org	Center for Elders' Independence (PACE)	08	20		1			H5405	002	0	2019	Alameda and West Contra Costa Counties		2		2			2						www.cei.elders.org	www.cei.elders.org										(510)433-1150		(510)433-1150		(510)433-1150		(510)433-1150										(510)433-1165		(510)433-1165		(510)433-1165		(510)433-1165																
H5406	001	0	1	20	08	H5406_001_0	1	1				05/24/2018	2019.01	05/24/2018 10:57:12 AM Pacific Daylight Time		05/24/2018 10:43:47 AM Pacific Daylight Time			05/24/2018 10:59:26 AM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	001	0	2019	Sacramento Counties		2		2			2						N/A	N/A	N/A									(916)424-8412	13415	(916)424-8412	13415	(916)424-8412	13422	(916)491-3422	13422									(916)393-1112		(916)393-1112		(916)393-1112		(916)393-1112																
H5406	002	0	1	20	08	H5406_002_0	1	1				05/24/2018	2019.01	05/24/2018 10:57:59 AM Pacific Daylight Time		05/24/2018 10:44:16 AM Pacific Daylight Time			05/24/2018 10:59:26 AM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	002	0	2019	Yolo Counties		2		2			2						N/A	N/A	N/A									(916)424-8412	13415	(916)424-8412	13415	(916)424-8412	13422	(916)491-3422	13422									(916)393-1112		(916)393-1112		(916)393-1112		(916)393-1112																
H5410	001	0	1	01	01	H5410_001_0	5	1				08/02/2018	2019.01	08/02/2018 05:54:08 PM Central Daylight Time	08/03/2018 09:22:30 AM Central Daylight Time	07/31/2018 08:49:28 PM Central Daylight Time			08/07/2018 11:33:06 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.lmchealthplans.com	Leon Medical Centers Health Plans - Leon Cares (HMO)	01	01		1			H5410	001	0	2019	Miami-Dade county		2	0	2			2						www.cignahealthspring.com	www.lmchealthplans.com		(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	004	0	1	01	01	H5410_004_0	4	1				07/20/2018	2019.01	07/20/2018 03:38:38 PM Central Daylight Time	07/16/2018 10:37:32 AM Central Daylight Time				07/21/2018 10:07:41 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H5410	004	0	2019	Northern Florida		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5410	013	0	1	01	01	H5410_013_0	7	1	2	1		07/20/2018	2019.01	07/20/2018 03:38:49 PM Central Daylight Time	08/03/2018 09:09:02 AM Central Daylight Time	07/31/2018 08:49:42 PM Central Daylight Time			08/07/2018 11:33:06 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H5410	013	0	2019	Northern Florida		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	018	0	1	01	01	H5410_018_0	6	1				08/01/2018	2019.01	08/01/2018 05:08:40 PM Central Daylight Time	08/03/2018 09:09:26 AM Central Daylight Time	07/31/2018 08:49:56 PM Central Daylight Time			08/07/2018 11:33:06 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H5410	018	0	2019	Northern Florida		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	024	0	1	01	01	H5410_024_0	7	1				08/01/2018	2019.01	08/01/2018 05:13:14 PM Central Daylight Time	08/07/2018 11:25:27 AM Central Daylight Time	07/31/2018 08:50:09 PM Central Daylight Time			08/07/2018 11:33:06 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H5410	024	0	2019	Orlando		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	025	0	1	01	01	H5410_025_0	8	1	2	1		07/20/2018	2019.01	07/20/2018 03:39:24 PM Central Daylight Time	08/03/2018 09:10:19 AM Central Daylight Time	07/31/2018 08:50:24 PM Central Daylight Time			08/07/2018 11:33:06 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H5410	025	0	2019	Orlando		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	807	0	1	01	01	H5410_807_0	2	1				05/22/2018	2019.01	05/22/2018 03:28:29 PM Central Daylight Time					06/01/2018 11:24:13 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H5410	807	0	2019	Florida		1	1308	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;12;14a;14d;15;17a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;16b;17a;17b;	1					1				
H5410	808	0	1	01	01	H5410_808_0	2	1				05/23/2018	2019.01	05/23/2018 12:26:24 PM Central Daylight Time					05/31/2018 03:41:52 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H5410	808	0	2019	Northern Florida		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1					1				
H5410	809	0	1	02	01	H5410_809_0	2	1				05/22/2018	2019.01	05/22/2018 03:58:33 PM Central Daylight Time					05/31/2018 03:41:52 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H5410	809	0	2019	Northern Florida		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1				
H5420	001	0	1	01	01	H5420_001_0	2	1				08/02/2018	2019.01	08/02/2018 04:14:49 PM Central Daylight Time	08/03/2018 10:34:31 AM Central Daylight Time	07/31/2018 07:47:22 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	UnitedHealthcare	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	01	01		1			H5420	001	0	2019	Miami-Dade County		2		2			2						www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	003	0	1	01	01	H5420_003_0	2	1				08/02/2018	2019.01	08/02/2018 04:15:04 PM Central Daylight Time	08/03/2018 10:35:48 AM Central Daylight Time	07/31/2018 07:47:46 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	UnitedHealthcare	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	01	01		1			H5420	003	0	2019	Broward County		2		2			2						www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	006	0	1	01	01	H5420_006_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:16:13 PM Central Daylight Time	08/03/2018 10:36:36 AM Central Daylight Time	07/31/2018 07:48:10 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	UnitedHealthcare	www.Medicaplans.com	Medica HealthCare Plans MedicareMax Plus (HMO SNP)	01	01		1			H5420	006	0	2019	Miami-Dade and Broward County		2		2			1	3		2		2	www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	007	0	1	01	01	H5422_007_0	7	1	2	1		08/07/2018	2019.01	08/07/2018 10:15:28 AM Eastern Daylight Time	08/06/2018 12:46:24 AM Eastern Daylight Time	08/01/2018 07:15:05 PM Eastern Daylight Time			08/07/2018 02:58:40 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H5422	007	0	2019	Select Counties in Georgia		2	43068	2			1	3		1		1	https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(844)887-6355		(844)887-6355		(844)227-8228		(844)227-8228		(844)887-6355		(844)887-6355		(844)227-8229		(844)227-8229		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	008	0	1	01	01	H5422_008_0	8	1				08/09/2018	2019.01	08/09/2018 03:32:16 PM Eastern Daylight Time	08/09/2018 03:35:54 PM Eastern Daylight Time	08/01/2018 08:20:16 PM Eastern Daylight Time			08/09/2018 04:36:18 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Essential (HMO)	01	01		1			H5422	008	0	2019	Select Counties in Georgia		2	11976	2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(800)797-1769		(800)797-1769		(855)690-7797		(855)690-7797		(844)364-2117		(844)364-2117		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	011	0	1	01	01	H5422_011_0	11	1				08/03/2018	2019.01	08/03/2018 09:32:25 PM Eastern Daylight Time	08/06/2018 12:48:26 AM Eastern Daylight Time	08/01/2018 08:21:02 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H5422	011	0	2019	Select Counties in Georgia		2	29040	2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(800)797-1769		(800)797-1769		(855)690-7797		(855)690-7797		(844)364-2117		(844)364-2117		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	803	0	1	01	01	H5422_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:29:22 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		1			H5422	803	0	2019	Georgia Select Counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	804	0	1	01	01	H5422_804_0	2	1				06/19/2018	2019.01	06/19/2018 01:29:42 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		1			H5422	804	0	2019	Georgia - Select Counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	806	0	2	01	01	H5422_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:29:58 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		2	1		H5422	806	0	2019	Georgia - Select counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	807	0	2	01	01	H5422_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:32:18 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	01	01		2	1		H5422	807	0	2019	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	808	0	1	01	01	H5422_808_0	2	1				06/19/2018	2019.01	06/19/2018 01:32:28 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	01	01		1			H5422	808	0	2019	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	809	0	1	01	01	H5422_809_0	2	1				06/19/2018	2019.01	06/19/2018 01:32:37 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	01	01		1			H5422	809	0	2019	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	810	0	2	01	01	H5422_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:32:54 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	01	01		2	1		H5422	810	0	2019	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	811	0	2	01	01	H5422_811_0	2	1				06/19/2018	2019.01	06/19/2018 01:33:11 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	Blue Value (HMO)	01	01		2	1		H5422	811	0	2019	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5425	001	0	1	01	01	H5425_001_0	4	1				07/18/2018	2019.01	07/18/2018 11:22:21 AM Pacific Daylight Time	08/01/2018 03:35:24 PM Pacific Daylight Time	08/01/2018 09:26:12 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	001	0	2019	Ventura County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	004	0	1	01	01	H5425_004_0	5	1				07/18/2018	2019.01	07/18/2018 11:22:44 AM Pacific Daylight Time	08/01/2018 03:40:24 PM Pacific Daylight Time	08/01/2018 09:27:41 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Signature offered by SCAN Health Plan (HMO)	01	01		1			H5425	004	0	2019	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	005	0	1	01	01	H5425_005_0	5	1				05/25/2018	2019.01	05/25/2018 12:47:12 PM Pacific Daylight Time	08/01/2018 03:47:14 PM Pacific Daylight Time	08/01/2018 09:28:59 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Classic offered by SCAN Health Plan (HMO)	01	01		1			H5425	005	0	2019	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	006	0	1	01	01	H5425_006_0	5	1				07/18/2018	2019.01	07/18/2018 11:23:01 AM Pacific Daylight Time	08/01/2018 03:52:58 PM Pacific Daylight Time	08/01/2018 09:31:46 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	006	0	2019	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	007	0	1	01	01	H5425_007_0	5	1				07/18/2018	2019.01	07/18/2018 11:23:12 AM Pacific Daylight Time	08/01/2018 04:03:02 PM Pacific Daylight Time	08/01/2018 09:32:38 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	007	0	2019	Orange County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	008	0	1	01	01	H5425_008_0	5	1				07/18/2018	2019.01	07/18/2018 11:23:21 AM Pacific Daylight Time	08/01/2018 04:10:08 PM Pacific Daylight Time	08/01/2018 09:33:26 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	008	0	2019	Riverside County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	009	0	1	01	01	H5425_009_0	5	1				07/18/2018	2019.01	07/18/2018 11:23:30 AM Pacific Daylight Time	08/01/2018 05:19:46 PM Pacific Daylight Time	08/01/2018 09:34:15 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	009	0	2019	San Bernardino County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	010	0	1	01	01	H5425_010_0	5	1	2	1		07/18/2018	2019.01	07/18/2018 10:33:06 AM Pacific Daylight Time	08/01/2018 05:54:18 PM Pacific Daylight Time	08/01/2018 09:34:59 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO SNP)	01	01		1			H5425	010	0	2019	Los Angeles, Riverside and San Bernardino Counties		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	019	0	1	01	01	H5425_019_0	4	1				06/01/2018	2019.01	06/01/2018 02:43:52 PM Pacific Daylight Time	08/01/2018 05:29:18 PM Pacific Daylight Time	08/01/2018 09:35:43 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	019	0	2019	San Francisco County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	020	0	1	01	01	H5425_020_0	4	1				06/01/2018	2019.01	06/01/2018 11:45:01 AM Pacific Daylight Time	08/01/2018 05:35:24 PM Pacific Daylight Time	08/01/2018 09:36:28 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	020	0	2019	Santa Clara County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	028	0	1	01	01	H5425_028_0	5	1		1		07/18/2018	2019.01	07/18/2018 10:32:23 AM Pacific Daylight Time	08/01/2018 05:46:00 PM Pacific Daylight Time	08/01/2018 09:37:15 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	028	0	2019	Orange County		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	029	0	1	01	01	H5425_029_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 04:00:57 PM Pacific Daylight Time	08/02/2018 05:45:06 PM Pacific Daylight Time	08/01/2018 09:38:36 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	029	0	2019	Los Angeles County		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	030	0	1	01	01	H5425_030_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 04:01:22 PM Pacific Daylight Time	08/02/2018 05:41:06 PM Pacific Daylight Time	08/01/2018 09:39:41 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	030	0	2019	Riverside County		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	031	0	1	01	01	H5425_031_0	4	1	2	1		07/03/2018	2019.01	07/03/2018 10:51:34 AM Pacific Daylight Time	08/01/2018 05:05:52 PM Pacific Daylight Time	08/01/2018 09:40:28 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	031	0	2019	San Bernardino County		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	033	0	1	01	01	H5425_033_0	5	1		1		07/03/2018	2019.01	07/03/2018 02:42:39 PM Pacific Daylight Time	08/01/2018 05:01:16 PM Pacific Daylight Time	08/01/2018 09:41:22 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	033	0	2019	Riverside and San Bernardino Counties		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	034	0	1	01	01	H5425_034_0	5	1		1		07/03/2018	2019.01	07/03/2018 02:42:45 PM Pacific Daylight Time	08/01/2018 05:24:42 PM Pacific Daylight Time	08/01/2018 09:42:11 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	034	0	2019	Los Angeles and Orange Counties		2		2			1	4			00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	040	0	1	01	01	H5425_040_0	5	1				08/01/2018	2019.01	08/01/2018 04:02:09 PM Pacific Daylight Time	08/01/2018 03:16:48 PM Pacific Daylight Time	08/01/2018 09:42:55 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Plus offered by SCAN Health Plan (HMO)	01	01		1			H5425	040	0	2019	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	045	0	1	01	01	H5425_045_0	5	1				08/01/2018	2019.01	08/01/2018 04:02:31 PM Pacific Daylight Time	08/03/2018 02:04:36 PM Pacific Daylight Time	08/01/2018 09:43:37 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	045	0	2019	Selected Southern and Northern CA Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	052	0	1	01	01	H5425_052_0	4	1				05/25/2018	2019.01	05/25/2018 12:49:15 PM Pacific Daylight Time	08/01/2018 04:42:32 PM Pacific Daylight Time	08/01/2018 09:44:22 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	052	0	2019	Napa and Sonoma Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	053	0	1	01	01	H5425_053_0	4	1		1		05/25/2018	2019.01	05/25/2018 12:49:09 PM Pacific Daylight Time	08/01/2018 04:37:44 PM Pacific Daylight Time	08/01/2018 09:45:07 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	053	0	2019	Napa and Sonoma Counties		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	054	0	1	01	01	H5425_054_0	4	1		1		05/25/2018	2019.01	05/25/2018 12:49:03 PM Pacific Daylight Time	08/01/2018 04:35:02 PM Pacific Daylight Time	08/01/2018 09:45:52 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	054	0	2019	Napa and Sonoma Counties		2		2			1	4			00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	055	0	1	01	01	H5425_055_0	5	1		1		07/03/2018	2019.01	07/03/2018 02:43:04 PM Pacific Daylight Time	08/01/2018 04:32:18 PM Pacific Daylight Time	08/01/2018 09:46:33 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Heart First offered by SCAN Health Plan (HMO SNP)	01	01		1			H5425	055	0	2019	San Diego County		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	061	0	1	01	01	H5425_061_0	5	1				07/03/2018	2019.01	07/03/2018 02:43:10 PM Pacific Daylight Time	08/01/2018 04:29:02 PM Pacific Daylight Time	08/01/2018 09:47:13 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic II (HMO)	01	01		1			H5425	061	0	2019	Riverside and San Bernardino Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	064	0	1	01	01	H5425_064_0	5	1				07/03/2018	2019.01	07/03/2018 02:43:17 PM Pacific Daylight Time	08/01/2018 03:42:06 PM Pacific Daylight Time	08/01/2018 09:47:55 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic II (HMO)	01	01		1			H5425	064	0	2019	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	065	0	1	01	01	H5425_065_0	5	1				07/03/2018	2019.01	07/03/2018 02:43:22 PM Pacific Daylight Time	08/01/2018 03:36:22 PM Pacific Daylight Time	08/01/2018 09:48:32 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	065	0	2019	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	066	0	1	01	01	H5425_066_0	5	1				07/18/2018	2019.01	07/18/2018 11:23:52 AM Pacific Daylight Time	08/01/2018 03:33:32 PM Pacific Daylight Time	08/01/2018 09:49:10 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	066	0	2019	Orange County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	067	0	1	01	01	H5425_067_0	6	1				07/03/2018	2019.01	07/03/2018 02:43:40 PM Pacific Daylight Time	08/01/2018 03:30:12 PM Pacific Daylight Time	08/01/2018 09:49:51 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	067	0	2019	Riverside County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	068	0	1	01	01	H5425_068_0	6	1				07/03/2018	2019.01	07/03/2018 02:43:35 PM Pacific Daylight Time	08/01/2018 03:25:46 PM Pacific Daylight Time	08/01/2018 09:50:31 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	068	0	2019	San Bernardino County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	803	0	1	01	01	H5425_803_0	3	1				07/18/2018	2019.01	07/18/2018 11:16:14 AM Pacific Daylight Time					07/18/2018 12:12:16 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	803	0	2019	Southern and Northern California Counties		1	37898	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	804	0	1	01	01	H5425_804_0	3	1				07/03/2018	2019.01	07/03/2018 10:53:30 AM Pacific Daylight Time					07/18/2018 12:12:16 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	804	0	2019	Southern and Northern California Counties		1	9427	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	052	0	1	01	01	H5427_052_0	6	1				05/10/2018	2019.01	05/10/2018 06:51:01 AM Eastern Daylight Time	06/03/2018 10:00:34 AM Eastern Daylight Time				06/04/2018 05:31:36 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Savings Plan (HMO)	01	01		1			H5427	052	0	2019	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5427	059	0	1	01	01	H5427_059_0	8	1				06/22/2018	2019.01	06/22/2018 10:47:56 AM Eastern Daylight Time	08/03/2018 09:24:06 AM Eastern Daylight Time	08/02/2018 04:55:28 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	059	0	2019	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	060	0	1	01	01	H5427_060_0	8	1				06/22/2018	2019.01	06/22/2018 10:48:12 AM Eastern Daylight Time	08/03/2018 09:25:10 AM Eastern Daylight Time	08/02/2018 04:56:16 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	060	0	2019	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	070	0	1	01	01	H5427_070_0	8	1		1		06/22/2018	2019.01	06/22/2018 10:48:29 AM Eastern Daylight Time	08/03/2018 09:26:12 AM Eastern Daylight Time	08/03/2018 02:39:34 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Care (HMO SNP)	01	01		1			H5427	070	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000000000010		www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	072	0	1	01	01	H5427_072_0	9	1		1		06/22/2018	2019.01	06/22/2018 10:48:46 AM Eastern Daylight Time	08/03/2018 09:27:22 AM Eastern Daylight Time	08/03/2018 02:40:22 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO SNP)	01	01		1			H5427	072	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000000000010		www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	077	0	1	01	01	H5427_077_0	9	1		1		06/22/2018	2019.01	06/22/2018 10:49:00 AM Eastern Daylight Time	08/03/2018 09:28:22 AM Eastern Daylight Time	08/02/2018 04:58:44 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO SNP)	01	01		1			H5427	077	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000100000000		www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	078	0	1	01	01	H5427_078_0	8	1	2	1		06/22/2018	2019.01	06/22/2018 10:49:14 AM Eastern Daylight Time	08/03/2018 09:31:42 AM Eastern Daylight Time	08/02/2018 04:59:32 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Partial (HMO SNP)	01	01		1			H5427	078	0	2019	Select Counties in Florida		2	0	2			1	3		2		2	www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	082	0	1	01	01	H5427_082_0	8	1		1		06/22/2018	2019.01	06/22/2018 10:49:29 AM Eastern Daylight Time	08/03/2018 09:33:28 AM Eastern Daylight Time	08/03/2018 02:41:08 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO SNP)	01	01		1			H5427	082	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000000000010		www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	083	0	1	01	01	H5427_083_0	8	1		1		06/22/2018	2019.01	06/22/2018 10:49:44 AM Eastern Daylight Time	08/03/2018 09:34:30 AM Eastern Daylight Time	08/02/2018 05:01:08 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO SNP)	01	01		1			H5427	083	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000100000000		www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	087	0	1	01	01	H5427_087_0	8	1	2	1		06/22/2018	2019.01	06/22/2018 10:50:01 AM Eastern Daylight Time	08/03/2018 09:35:34 AM Eastern Daylight Time	08/03/2018 02:42:06 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Full (HMO SNP)	01	01		1			H5427	087	0	2019	Select Counties in Florida		2	0	2			1	3		1		1	www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	088	0	1	01	01	H5427_088_0	8	1				06/22/2018	2019.01	06/22/2018 10:50:18 AM Eastern Daylight Time	08/03/2018 09:36:34 AM Eastern Daylight Time	08/02/2018 05:02:44 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	088	0	2019	select counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	089	0	1	01	01	H5427_089_0	8	1				06/22/2018	2019.01	06/22/2018 10:50:31 AM Eastern Daylight Time	08/03/2018 09:37:34 AM Eastern Daylight Time	08/02/2018 05:03:32 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	089	0	2019	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	091	0	1	01	01	H5427_091_0	9	1				06/22/2018	2019.01	06/22/2018 10:50:45 AM Eastern Daylight Time	08/03/2018 09:40:20 AM Eastern Daylight Time	08/02/2018 05:04:18 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	091	0	2019	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	092	0	1	01	01	H5427_092_0	8	1				06/22/2018	2019.01	06/22/2018 10:51:00 AM Eastern Daylight Time	08/03/2018 09:41:24 AM Eastern Daylight Time	08/03/2018 02:42:52 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	092	0	2019	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	093	0	1	01	01	H5427_093_0	8	1				06/22/2018	2019.01	06/22/2018 10:51:13 AM Eastern Daylight Time	08/03/2018 09:42:22 AM Eastern Daylight Time	08/03/2018 02:43:42 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	093	0	2019	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	094	0	1	01	01	H5427_094_0	9	1				06/22/2018	2019.01	06/22/2018 10:51:28 AM Eastern Daylight Time	08/03/2018 09:43:22 AM Eastern Daylight Time	08/02/2018 05:06:42 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	094	0	2019	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	096	0	1	01	01	H5427_096_0	8	1				06/22/2018	2019.01	06/22/2018 10:51:42 AM Eastern Daylight Time	08/03/2018 09:44:32 AM Eastern Daylight Time	08/02/2018 05:07:30 PM Eastern Daylight Time			08/03/2018 04:48:04 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Rewards Plan Rx (HMO)	01	01		1			H5427	096	0	2019	Select Counties in Florida		2		2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5430	001	0	1	01	01	H5430_001_0	4	1	2	1		06/01/2018	2019.01	06/01/2018 03:19:10 PM Eastern Daylight Time	08/06/2018 05:56:52 PM Eastern Daylight Time	08/01/2018 02:47:19 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	ONECARE BY CARE1ST HEALTH PLAN ARIZONA INC.	Care1st+	www.care1staz.com/az/healthplans/onecare	WellCare Liberty (HMO SNP)	01	01		1			H5430	001	0	2019	Counties:  Maricopa and Pima		2	25015	2			1	3		1		1	www.care1staz.com/az/healthplans/onecare	www.care1staz.com/az/healthplans/onecare	www.care1staz.com/az/healthplans/onecare	(877)778-1855		(877)778-1855		(866)527-0056		(866)527-0056		(877)778-1855		(877)778-1855		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5431	001	0	1	01	01	H5431_001_0	5	1				08/06/2018	2019.01	08/06/2018 08:06:42 AM Eastern Daylight Time	08/01/2018 01:17:22 PM Eastern Daylight Time	08/01/2018 01:28:14 PM Eastern Daylight Time			08/06/2018 08:07:37 AM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun SunPlus Advantage Plan (HMO)	01	01		1			H5431	001	0	2019	Miami-Dade		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5431	006	0	1	01	01	H5431_006_0	5	1				06/01/2018	2019.01	06/01/2018 07:57:58 PM Eastern Daylight Time	08/03/2018 05:48:02 PM Eastern Daylight Time	08/01/2018 01:27:13 PM Eastern Daylight Time			08/06/2018 08:07:37 AM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun MediMax (HMO)	01	01		1			H5431	006	0	2019	Broward and Miami-Dade		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5431	012	0	1	01	01	H5431_012_0	5	1				06/01/2018	2019.01	06/01/2018 07:59:35 PM Eastern Daylight Time	08/01/2018 01:18:37 PM Eastern Daylight Time	08/01/2018 01:29:00 PM Eastern Daylight Time			08/06/2018 08:07:37 AM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun HealthAdvantage Plan (HMO)	01	01		1			H5431	012	0	2019	Broward County		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5433	001	0	1	01	01	H5433_001_0	6	1	2	1		07/11/2018	2019.01	07/11/2018 09:28:44 AM Pacific Daylight Time	06/01/2018 06:20:36 PM Pacific Daylight Time	07/11/2018 09:10:02 AM Pacific Daylight Time			07/12/2018 01:36:41 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	OneCare	www.caloptima.org/onecare	OneCare (HMO SNP)	01	01		1			H5433	001	0	2019	Orange County, California		2	15888	2			1	3		1		1	www.caloptima.org/onecare	https://www.caloptima.org/en/Members/OneCare/MedicarePartD.aspx	www.caloptima.org/onecare	(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2	2			
H5434	002	0	1	04	01	H5434_002_0	8	1				08/07/2018	2019.01	08/07/2018 09:38:59 AM Eastern Daylight Time	08/06/2018 02:00:50 PM Eastern Daylight Time	07/31/2018 07:37:00 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Select (PPO)	01	04		1			H5434	002	0	2019	Select counties in S.FL/ W.FL/C.FL,N.C. FL/N.W FL		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2						2			
H5434	023	0	1	04	01	H5434_023_0	8	1				08/07/2018	2019.01	08/07/2018 09:40:34 AM Eastern Daylight Time	08/06/2018 02:01:55 PM Eastern Daylight Time	07/31/2018 07:38:30 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/Medicare	BlueMedicare Value (PPO)	01	04		1			H5434	023	0	2019	Pinellas 2		2	4000	2			2						FloridaBlue.com/Medicare	MyPrime.com	FloridaBlue.com/Medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2						2			
H5434	024	0	1	04	01	H5434_024_0	8	1				08/07/2018	2019.01	08/07/2018 09:42:00 AM Eastern Daylight Time	08/06/2018 02:02:57 PM Eastern Daylight Time	07/31/2018 07:40:36 PM Eastern Daylight Time			08/07/2018 10:31:05 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	024	0	2019	Manatee & Sarasota		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2						2			
H5434	025	0	1	04	01	H5434_025_0	10	1				08/09/2018	2019.01	08/09/2018 01:28:08 PM Eastern Daylight Time	08/06/2018 02:04:25 PM Eastern Daylight Time	07/31/2018 07:42:21 PM Eastern Daylight Time			08/09/2018 01:40:26 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	025	0	2019	Escambia & Santa Rosa		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2						2			
H5434	801	0	1	04	01	H5434_801_0	6	1				06/01/2018	2019.01	06/01/2018 04:24:44 PM Eastern Daylight Time					06/04/2018 12:31:16 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group PPO (PPO)	01	04		1			H5434	801	0	2019	State of Florida with National Coverage		1	41300	2			2						www.myprime.com	MyPrime.com	www.BlueMedicareFL.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	1a;1b;2;5;6;7c;7e;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	1	1a;18a;	1									
H5434	802	0	1	04	01	H5434_802_0	6	1				06/01/2018	2019.01	06/01/2018 04:25:09 PM Eastern Daylight Time					06/04/2018 12:31:16 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group PPO (PPO)	01	04		1			H5434	802	0	2019	State of Florida with National Coverage		1	6000	2			2						www.myprime.com	MyPrime.com	www.BlueMedicareFL.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	1a;1b;2;5;6;7c;7e;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	1	1a;18a;	1									
H5435	001	0	1	09	04	H5435_001_0	1	1				06/02/2018	2019.01	06/02/2018 11:55:47 AM Central Daylight Time	06/01/2018 04:13:04 PM Central Daylight Time				06/02/2018 11:57:36 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Essential (PFFS)	04	09	2	1			H5435	001	0	2019	Select counties nationwide		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2										2	2			
H5435	024	0	1	09	04	H5435_024_0	2	1				05/28/2018	2019.01	05/28/2018 04:14:57 PM Central Daylight Time	08/03/2018 10:38:53 AM Central Daylight Time	07/31/2018 07:48:36 PM Central Daylight Time			08/06/2018 09:27:14 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Rx (PFFS)	04	09	2	1			H5435	024	0	2019	Select counties nationwide		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757		(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2										2	2			
H5439	010	0	1	04	01	H5439_010_0	4	1				07/18/2018	2019.01	07/18/2018 03:26:00 PM US Mountain Standard Time	06/04/2018 06:29:46 PM Pacific Daylight Time				07/19/2018 01:25:20 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Aqua (PPO)	01	04		1			H5439	010	0	2019	10 Northern Counties		2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5439	011	0	1	04	01	H5439_011_0	5	1				08/01/2018	2019.01	08/01/2018 03:49:47 PM Pacific Daylight Time	08/03/2018 05:52:11 PM Pacific Daylight Time	08/03/2018 05:51:18 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 1 (PPO)	01	04		1			H5439	011	0	2019	10 Northern Counties		2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	012	0	1	04	01	H5439_012_0	4	1				07/18/2018	2019.01	07/18/2018 03:26:06 PM US Mountain Standard Time	06/04/2018 06:36:26 PM Pacific Daylight Time				07/19/2018 01:25:20 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Aqua (PPO)	01	04		1			H5439	012	0	2019	Douglas, Jackson, Josephine		2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5439	013	0	1	04	01	H5439_013_0	5	1				08/01/2018	2019.01	08/01/2018 03:50:00 PM Pacific Daylight Time	08/03/2018 05:52:54 PM Pacific Daylight Time	08/03/2018 05:53:28 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 1 (PPO)	01	04		1			H5439	013	0	2019	Douglas, Jackson, Josephine		2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	014	1	1	04	01	H5439_014_1	5	1				08/01/2018	2019.01	08/01/2018 03:50:14 PM Pacific Daylight Time	08/03/2018 05:54:13 PM Pacific Daylight Time	08/03/2018 05:54:34 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	01	04		1			H5439	014	1	2019	10 Northern Counties	Clackamas, Lane, Multnomah, Washington	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	014	2	1	04	01	H5439_014_2	5	1				08/01/2018	2019.01	08/01/2018 03:50:26 PM Pacific Daylight Time	08/03/2018 05:55:09 PM Pacific Daylight Time	08/03/2018 05:55:28 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	01	04		1			H5439	014	2	2019	10 Northern Counties	Benton, Linn, Yamhill	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	014	3	1	04	01	H5439_014_3	6	1				08/01/2018	2019.01	08/01/2018 03:50:41 PM Pacific Daylight Time	08/03/2018 05:56:13 PM Pacific Daylight Time	08/03/2018 05:56:55 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	01	04		1			H5439	014	3	2019	10 Northern Counties	Marion, Polk	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	014	4	1	04	01	H5439_014_4	6	1				08/01/2018	2019.01	08/01/2018 03:50:53 PM Pacific Daylight Time	08/03/2018 05:57:30 PM Pacific Daylight Time	08/03/2018 05:57:54 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	01	04		1			H5439	014	4	2019	10 Northern Counties	Clark, WA	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	015	0	1	04	01	H5439_015_0	5	1				08/01/2018	2019.01	08/01/2018 03:51:15 PM Pacific Daylight Time	08/03/2018 05:59:03 PM Pacific Daylight Time	08/03/2018 05:59:23 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 3 (PPO)	01	04		1			H5439	015	0	2019	Douglas, Josephine		2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	016	1	1	04	01	H5439_016_1	5	1				08/01/2018	2019.01	08/01/2018 03:51:29 PM Pacific Daylight Time	08/03/2018 06:00:00 PM Pacific Daylight Time	08/03/2018 06:00:35 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	01	04		1			H5439	016	1	2019	Jackson, Josephine, Douglas	Jackson	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	016	2	1	04	01	H5439_016_2	5	1				08/01/2018	2019.01	08/01/2018 03:51:55 PM Pacific Daylight Time	08/03/2018 06:01:18 PM Pacific Daylight Time	08/03/2018 06:01:36 PM Pacific Daylight Time			08/03/2018 06:34:12 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	01	04		1			H5439	016	2	2019	Jackson, Josephine, Douglas	Josephine, Douglas	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	801	0	1	04	01	H5439_801_0	3	1				05/29/2018	2019.01	05/29/2018 05:29:53 PM Pacific Daylight Time					06/04/2018 06:51:00 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	801	0	2019	48 States - All Counties		1	100	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5439	802	0	1	04	01	H5439_802_0	3	1				05/29/2018	2019.01	05/29/2018 05:29:59 PM Pacific Daylight Time					06/04/2018 06:51:00 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	802	0	2019	48 States - All Counties		1	100	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5439	803	0	1	04	01	H5439_803_0	4	1				05/29/2018	2019.01	05/29/2018 05:30:05 PM Pacific Daylight Time					06/04/2018 07:53:47 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	803	0	2019	48 States - All Counties		1	100	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5441	001	0	1	48	05	H5441_001_0	3	1				07/17/2018	2019.01	07/17/2018 10:54:40 AM Eastern Daylight Time					07/17/2018 10:54:54 AM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H5441	001	0	2019	Counties: Ki, Qu, Brx, NY, Rich, Wes, and Na		2		2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H5454	001	0	1	01	01	H5454_001_0	8	1				06/07/2018	2019.01	06/07/2018 11:23:43 AM Central Daylight Time	08/06/2018 02:10:50 PM Central Daylight Time	08/06/2018 02:10:50 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	01	01		1			H5454	001	0	2019	Rockford, Metro St Louis		2	13115	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(180)000-0000				(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		(180)000-0000		2					2					2	2			
H5454	002	0	1	01	01	H5454_002_0	8	1				06/07/2018	2019.01	06/07/2018 11:23:56 AM Central Daylight Time	08/06/2018 02:10:50 PM Central Daylight Time	08/06/2018 02:10:50 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	01	01		1			H5454	002	0	2019	Metro Chicago		2	28104	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(800)000-0000				(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		2					2					2	2			
H5454	003	0	1	01	01	H5454_003_0	9	1				06/07/2018	2019.01	06/07/2018 11:24:08 AM Central Daylight Time	08/06/2018 02:10:50 PM Central Daylight Time	08/07/2018 10:44:56 AM Central Daylight Time			08/07/2018 11:16:10 AM Central Daylight Time	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (HMO)	01	01		1			H5454	003	0	2019	Rockford, Metro St. Louis		2	5621	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(800)000-0000				(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		2					2					2	2			
H5454	004	0	1	01	01	H5454_004_0	8	1				06/07/2018	2019.01	06/07/2018 11:24:22 AM Central Daylight Time	08/06/2018 02:10:50 PM Central Daylight Time	08/06/2018 02:10:50 PM Central Daylight Time			08/06/2018 02:37:15 PM Central Daylight Time	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (HMO)	01	01		1			H5454	004	0	2019	Metro Chicago		2	28104	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com			(800)000-0000				(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		(800)000-0000		2					2					2	2			
H5471	064	0	1	01	01	H5471_064_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 11:19:37 AM Eastern Daylight Time	08/06/2018 12:49:25 AM Eastern Daylight Time	08/01/2018 07:16:57 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	064	0	2019	Miami-Dade		2	284687	2			1	3		2		1	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	065	0	1	01	01	H5471_065_0	6	1				08/03/2018	2019.01	08/03/2018 11:19:46 AM Eastern Daylight Time	08/06/2018 12:50:25 AM Eastern Daylight Time	08/01/2018 07:18:27 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	065	0	2019	Miami-Dade		2	148417	2			2						www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	066	0	1	01	01	H5471_066_0	5	1	2	1		08/05/2018	2019.01	08/05/2018 03:27:32 PM Eastern Daylight Time	08/06/2018 12:51:25 AM Eastern Daylight Time	08/01/2018 07:19:53 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	066	0	2019	Polk		2	82955	2			1	3		2		1	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	067	0	1	01	01	H5471_067_0	6	1		1		07/16/2018	2019.01	07/16/2018 11:29:01 AM Eastern Daylight Time	08/06/2018 12:52:25 AM Eastern Daylight Time	08/01/2018 07:21:17 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	067	0	2019	Miami-Dade		2	246	2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	068	0	1	01	01	H5471_068_0	6	1		1		08/03/2018	2019.01	08/03/2018 11:10:06 AM Eastern Daylight Time	08/06/2018 12:53:27 AM Eastern Daylight Time	08/01/2018 07:22:49 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	068	0	2019	Miami-Dade		2	3549	2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	069	0	1	01	01	H5471_069_0	6	1		1		08/03/2018	2019.01	08/03/2018 11:23:03 AM Eastern Daylight Time	08/06/2018 12:54:27 AM Eastern Daylight Time	08/01/2018 07:24:02 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	069	0	2019	Miami-Dade		2	27164	2			1	4			00000010000000000000		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	070	0	1	01	01	H5471_070_0	6	1		1		08/03/2018	2019.01	08/03/2018 11:23:21 AM Eastern Daylight Time	08/06/2018 12:55:27 AM Eastern Daylight Time	08/01/2018 07:25:22 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	070	0	2019	Polk		2	22060	2			1	4			00000010000000000000		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	071	0	1	01	01	H5471_071_0	6	1				08/03/2018	2019.01	08/03/2018 11:23:34 AM Eastern Daylight Time	08/06/2018 12:56:28 AM Eastern Daylight Time	08/01/2018 07:26:39 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	071	0	2019	Polk		2	47355	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	072	0	1	01	01	H5471_072_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 11:38:14 AM Eastern Daylight Time	08/06/2018 12:57:28 AM Eastern Daylight Time	08/01/2018 07:27:59 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	072	0	2019	Orange, Osceola, Seminole		2	14935	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	073	0	1	01	01	H5471_073_0	6	1		1		08/03/2018	2019.01	08/03/2018 11:38:00 AM Eastern Daylight Time	08/06/2018 12:58:28 AM Eastern Daylight Time	08/01/2018 07:29:20 PM Eastern Daylight Time			08/06/2018 07:29:00 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	073	0	2019	Orange, Osceola, Seminole		2	10987	2			1	4			00000010000000000000		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	074	0	1	01	01	H5471_074_0	6	1				08/03/2018	2019.01	08/03/2018 11:37:48 AM Eastern Daylight Time	08/06/2018 12:59:29 AM Eastern Daylight Time	08/01/2018 07:30:37 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	074	0	2019	Orange, Osceola, Seminole		2	54175	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	075	0	1	01	01	H5471_075_0	6	1		1		08/03/2018	2019.01	08/03/2018 11:37:19 AM Eastern Daylight Time	08/06/2018 01:00:28 AM Eastern Daylight Time	08/01/2018 07:32:22 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	075	0	2019	Hernando, Hillsborough, Pasco, Pinellas		2	2428	2			1	4			00000010000000000000		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	076	0	1	01	01	H5471_076_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 09:09:35 PM Eastern Daylight Time	08/06/2018 01:01:29 AM Eastern Daylight Time	08/01/2018 07:34:09 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	076	0	2019	Broward		2	7630	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	077	0	1	01	01	H5471_077_0	6	1				08/03/2018	2019.01	08/03/2018 11:51:55 AM Eastern Daylight Time	08/06/2018 01:02:28 AM Eastern Daylight Time	08/01/2018 07:35:54 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	077	0	2019	Broward		2	15720	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	078	0	1	01	01	H5471_078_0	6	1				08/03/2018	2019.01	08/03/2018 11:53:29 AM Eastern Daylight Time	08/06/2018 01:03:28 AM Eastern Daylight Time	08/01/2018 07:37:33 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	078	0	2019	Hernando, Hillsborough, Pasco, Pinellas		2	14064	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	079	0	1	01	01	H5471_079_0	6	1		1		08/03/2018	2019.01	08/03/2018 11:53:55 AM Eastern Daylight Time	08/06/2018 01:04:28 AM Eastern Daylight Time	08/01/2018 07:39:41 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	079	0	2019	Broward		2	59	2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	080	0	1	01	01	H5471_080_0	6	1		1		08/03/2018	2019.01	08/03/2018 12:25:39 PM Eastern Daylight Time	08/06/2018 01:05:27 AM Eastern Daylight Time	08/01/2018 07:41:27 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	080	0	2019	Broward		2	1177	2			1	4			00000010000000000000		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	081	0	1	01	01	H5471_081_0	6	1		1		08/03/2018	2019.01	08/03/2018 12:27:35 PM Eastern Daylight Time	08/06/2018 01:06:27 AM Eastern Daylight Time	08/01/2018 07:43:05 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	081	0	2019	Broward		2	59	2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	082	0	1	01	01	H5471_082_0	5	1	2	1		08/04/2018	2019.01	08/04/2018 12:36:23 PM Eastern Daylight Time	08/06/2018 01:07:27 AM Eastern Daylight Time	08/01/2018 07:45:07 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	082	0	2019	Hernando, Hillsborough, Pasco, Pinellas		2	11526	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	083	0	1	01	01	H5471_083_0	6	1				08/03/2018	2019.01	08/03/2018 12:29:54 PM Eastern Daylight Time	08/06/2018 01:08:27 AM Eastern Daylight Time	08/01/2018 07:47:18 PM Eastern Daylight Time			08/06/2018 07:35:48 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	083	0	2019	Palm Beach		2	5375	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	084	0	1	01	01	H5471_084_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 12:31:18 PM Eastern Daylight Time	08/06/2018 01:09:27 AM Eastern Daylight Time	08/01/2018 07:48:56 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	084	0	2019	Palm Beach		2	1960	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	085	0	1	01	01	H5471_085_0	6	1		1		08/03/2018	2019.01	08/03/2018 12:32:08 PM Eastern Daylight Time	08/06/2018 01:10:27 AM Eastern Daylight Time	08/01/2018 07:50:21 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	085	0	2019	Palm Beach		2	118	2			1	4			00000010000000000000		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	086	0	1	01	01	H5471_086_0	5	1	2	1		08/05/2018	2019.01	08/05/2018 03:27:58 PM Eastern Daylight Time	08/06/2018 01:11:26 AM Eastern Daylight Time	08/01/2018 07:51:47 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Advantage (HMO SNP)	01	01		1			H5471	086	0	2019	Orange, Osceola, Seminole		2	5090	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	087	0	1	01	01	H5471_087_0	5	1	2	1		08/05/2018	2019.01	08/05/2018 03:29:33 PM Eastern Daylight Time	08/06/2018 01:12:26 AM Eastern Daylight Time	08/01/2018 07:53:33 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Advantage (HMO SNP)	01	01		1			H5471	087	0	2019	Broward		2	1963	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	088	0	1	01	01	H5471_088_0	5	1	2	1		08/04/2018	2019.01	08/04/2018 12:37:42 PM Eastern Daylight Time	08/06/2018 01:13:25 AM Eastern Daylight Time	08/01/2018 07:54:51 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Advantage (HMO SNP)	01	01		1			H5471	088	0	2019	Hernando, Hillsborough, Pasco, Pinellas		2	6013	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	089	0	1	01	01	H5471_089_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 01:48:49 PM Eastern Daylight Time	08/06/2018 01:14:24 AM Eastern Daylight Time	08/01/2018 07:56:31 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Advantage (HMO SNP)	01	01		1			H5471	089	0	2019	Palm Beach		2	1714	2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	090	0	1	01	01	H5471_090_0	6	1		1		08/06/2018	2019.01	08/06/2018 12:30:47 PM Eastern Daylight Time	08/06/2018 01:15:24 AM Eastern Daylight Time	08/01/2018 07:58:00 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	090	0	2019	Polk		2	59	2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	091	0	1	01	01	H5471_091_0	6	1		1		08/03/2018	2019.01	08/03/2018 01:52:29 PM Eastern Daylight Time	08/06/2018 01:16:24 AM Eastern Daylight Time	08/01/2018 07:59:38 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	091	0	2019	Polk		2	59	2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	092	0	1	01	01	H5471_092_0	6	1		1		08/03/2018	2019.01	08/03/2018 01:52:49 PM Eastern Daylight Time	08/06/2018 01:17:24 AM Eastern Daylight Time	08/01/2018 08:01:02 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	092	0	2019	Orange, Osceola, Seminole		2	53	2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	093	0	1	01	01	H5471_093_0	6	1		1		08/03/2018	2019.01	08/03/2018 01:53:14 PM Eastern Daylight Time	08/06/2018 01:18:25 AM Eastern Daylight Time	08/01/2018 08:02:47 PM Eastern Daylight Time			08/06/2018 07:43:07 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	093	0	2019	Orange, Osceola, Seminole		2	53	2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	094	0	1	01	01	H5471_094_0	6	1		1		08/03/2018	2019.01	08/03/2018 01:53:42 PM Eastern Daylight Time	08/06/2018 01:19:25 AM Eastern Daylight Time	08/01/2018 08:04:30 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	094	0	2019	Hernando, Hillsborough, Pasco, Pinellas		2	35	2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	095	0	1	01	01	H5471_095_0	6	1		1		08/03/2018	2019.01	08/03/2018 01:54:27 PM Eastern Daylight Time	08/06/2018 01:20:26 AM Eastern Daylight Time	08/01/2018 08:06:22 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	095	0	2019	Hernando, Hillsborough, Pasco, Pinellas		2	35	2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	096	0	1	01	01	H5471_096_0	6	1		1		08/03/2018	2019.01	08/03/2018 01:55:02 PM Eastern Daylight Time	08/06/2018 01:21:26 AM Eastern Daylight Time	08/01/2018 08:08:07 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	096	0	2019	Palm Beach		2	36	2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	097	0	1	01	01	H5471_097_0	6	1		1		08/03/2018	2019.01	08/03/2018 02:00:01 PM Eastern Daylight Time	08/06/2018 01:22:26 AM Eastern Daylight Time	08/01/2018 08:09:55 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	097	0	2019	Palm Beach		2	36	2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	098	0	1	01	01	H5471_098_0	6	1				08/06/2018	2019.01	08/06/2018 10:12:41 AM Eastern Daylight Time	08/06/2018 01:23:26 AM Eastern Daylight Time	08/01/2018 08:11:37 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Select (HMO)	01	01		1			H5471	098	0	2019	Orange, Osceola, Seminole		2	786	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	099	0	1	01	01	H5471_099_0	6	1				08/04/2018	2019.01	08/04/2018 10:39:18 AM Eastern Daylight Time	08/06/2018 01:24:29 AM Eastern Daylight Time	08/01/2018 08:13:35 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Select (HMO)	01	01		1			H5471	099	0	2019	Hernando, Hillsborough, Pasco, Pinellas		2	204	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	100	0	1	01	01	H5471_100_0	6	1				08/06/2018	2019.01	08/06/2018 10:21:02 AM Eastern Daylight Time	08/06/2018 01:25:29 AM Eastern Daylight Time	08/01/2018 08:15:32 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Select (HMO)	01	01		1			H5471	100	0	2019	Broward		2	226	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	101	0	1	01	01	H5471_101_0	6	1				08/03/2018	2019.01	08/03/2018 03:22:30 PM Eastern Daylight Time	08/06/2018 01:26:28 AM Eastern Daylight Time	08/01/2018 08:17:17 PM Eastern Daylight Time			08/06/2018 07:49:32 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Select (HMO)	01	01		1			H5471	101	0	2019	Palm Beach		2	80	2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	001	0	1	01	01	H5475_001_0	13	1	2	1		07/23/2018	2019.01	07/23/2018 12:31:48 PM Eastern Daylight Time	08/02/2018 05:40:58 PM Eastern Daylight Time	08/02/2018 10:56:08 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra (HMO SNP)	01	01		1			H5475	001	0	2019	Genesee, Macomb, Saginaw, Oakland & Wayne Counties		2	55964	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	003	0	1	01	01	H5475_003_0	8	1				07/23/2018	2019.01	07/23/2018 12:32:08 PM Eastern Daylight Time	08/02/2018 05:42:04 PM Eastern Daylight Time	08/02/2018 10:56:52 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Elite (HMO)	01	01		1			H5475	003	0	2019	Genesee, Macomb, Saginaw, Oakland & Wayne Counties		2	4696	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	004	0	1	01	01	H5475_004_0	8	1	2	1		07/23/2018	2019.01	07/23/2018 12:32:29 PM Eastern Daylight Time	08/02/2018 05:43:12 PM Eastern Daylight Time	08/02/2018 10:57:38 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra (HMO SNP)	01	01		1			H5475	004	0	2019	Barry, Kalamazoo, Kent, Muskegon, Ottawa Counties		2	13223	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	005	0	1	01	01	H5475_005_0	8	1				07/23/2018	2019.01	07/23/2018 12:32:47 PM Eastern Daylight Time	08/02/2018 05:44:20 PM Eastern Daylight Time	08/02/2018 10:58:22 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	005	0	2019	Barry, Kalamazoo, Kent, Muskegon, Ottawa Counties		2	14933	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	006	0	1	01	01	H5475_006_0	8	1				07/23/2018	2019.01	07/23/2018 12:33:08 PM Eastern Daylight Time	08/02/2018 05:45:28 PM Eastern Daylight Time	08/02/2018 10:59:08 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	006	0	2019	GEN, MAC, SAG, OAK & WAY in MI and DuPage in IL		2	69276	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	007	0	1	01	01	H5475_007_0	8	1				07/23/2018	2019.01	07/23/2018 12:33:52 PM Eastern Daylight Time	08/02/2018 05:46:34 PM Eastern Daylight Time	08/02/2018 10:59:54 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Enhanced (HMO)	01	01		1			H5475	007	0	2019	Genesee, Macomb, Saginaw, Oakland & Wayne Counties		2	8409	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	008	0	1	01	01	H5475_008_0	8	1	2	1		07/23/2018	2019.01	07/23/2018 12:34:14 PM Eastern Daylight Time	08/02/2018 05:47:40 PM Eastern Daylight Time	08/02/2018 11:00:38 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra (HMO SNP)	01	01		1			H5475	008	0	2019	Livingston, Monroe, Washtenaw Counties		2	5530	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	009	0	1	01	01	H5475_009_0	8	1				07/23/2018	2019.01	07/23/2018 12:34:42 PM Eastern Daylight Time	08/02/2018 05:48:48 PM Eastern Daylight Time	08/02/2018 11:01:24 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	009	0	2019	Livingston, Monroe, Washtenaw Counties		2	7256	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	010	0	1	01	01	H5475_010_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 09:34:00 AM Eastern Daylight Time	08/02/2018 05:49:56 PM Eastern Daylight Time	08/02/2018 11:02:08 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra (HMO SNP)	01	01		1			H5475	010	0	2019	Fulton, Henry, Lucas and Wood Counties		2	5126	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	011	0	1	01	01	H5475_011_0	8	1				07/23/2018	2019.01	07/23/2018 12:36:02 PM Eastern Daylight Time	08/02/2018 05:51:02 PM Eastern Daylight Time	08/02/2018 11:02:54 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	011	0	2019	Fulton, Henry, Lucas and Wood Counties		2	9399	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	012	0	1	01	01	H5475_012_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 09:34:20 AM Eastern Daylight Time	08/02/2018 05:52:10 PM Eastern Daylight Time	08/02/2018 11:03:40 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra (HMO SNP)	01	01		1			H5475	012	0	2019	Clermont and Hamilton Counties		2	5425	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	013	0	1	01	01	H5475_013_0	8	1				07/23/2018	2019.01	07/23/2018 12:36:38 PM Eastern Daylight Time	08/02/2018 05:53:16 PM Eastern Daylight Time	08/02/2018 11:04:24 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	013	0	2019	Clermont and Hamilton Counties		2	12912	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	014	0	1	01	01	H5475_014_0	8	1				07/23/2018	2019.01	07/23/2018 12:37:09 PM Eastern Daylight Time	08/02/2018 05:54:24 PM Eastern Daylight Time	08/02/2018 11:05:10 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Enhanced (HMO)	01	01		1			H5475	014	0	2019	Clermont and Hamilton Counties		2	4872	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	015	0	1	01	01	H5475_015_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 09:34:40 AM Eastern Daylight Time	08/02/2018 05:55:30 PM Eastern Daylight Time	08/02/2018 11:05:54 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra (HMO SNP)	01	01		1			H5475	015	0	2019	Butler County		2	3183	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	016	0	1	01	01	H5475_016_0	8	1				08/07/2018	2019.01	08/07/2018 09:55:16 AM Eastern Daylight Time	08/02/2018 05:56:38 PM Eastern Daylight Time	08/02/2018 11:06:38 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	016	0	2019	Butler County		2	4335	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	019	0	1	01	01	H5475_019_0	8	1				07/23/2018	2019.01	07/23/2018 12:38:07 PM Eastern Daylight Time	08/02/2018 05:57:44 PM Eastern Daylight Time	08/02/2018 11:07:22 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	019	0	2019	Greater South Bend		2	1000	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	020	0	1	01	01	H5475_020_0	8	1				08/07/2018	2019.01	08/07/2018 09:35:52 AM Eastern Daylight Time	08/02/2018 05:58:50 PM Eastern Daylight Time	08/02/2018 11:08:06 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Edge (HMO)	01	01		1			H5475	020	0	2019	Greater South Bend		2	9088	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	021	0	1	01	01	H5475_021_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 09:35:35 AM Eastern Daylight Time	08/02/2018 05:59:56 PM Eastern Daylight Time	08/02/2018 11:08:52 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra (HMO SNP)	01	01		1			H5475	021	0	2019	Greater Cleveland		2	1000	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	022	0	1	01	01	H5475_022_0	8	1				07/23/2018	2019.01	07/23/2018 12:39:16 PM Eastern Daylight Time	08/02/2018 06:01:04 PM Eastern Daylight Time	08/02/2018 11:09:36 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5475	022	0	2019	Greater Cleveland		2	12000	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	023	0	1	01	01	H5475_023_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 09:56:54 AM Eastern Daylight Time	08/02/2018 06:02:10 PM Eastern Daylight Time	08/02/2018 11:10:20 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra Smile (HMO SNP)	01	01		1			H5475	023	0	2019	Greater Detroit		2	1000	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	024	0	1	01	01	H5475_024_0	11	1				08/07/2018	2019.01	08/07/2018 04:59:49 PM Eastern Daylight Time	08/02/2018 06:03:18 PM Eastern Daylight Time	08/02/2018 11:11:04 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Elite Smile (HMO)	01	01		1			H5475	024	0	2019	Greater Detroit		2	12000	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	025	0	1	01	01	H5475_025_0	8	1				07/23/2018	2019.01	07/23/2018 12:40:08 PM Eastern Daylight Time	08/02/2018 06:04:26 PM Eastern Daylight Time	08/02/2018 11:11:48 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Elite Clarity (HMO)	01	01		1			H5475	025	0	2019	Greater Detroit		2	12000	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	026	0	1	01	01	H5475_026_0	8	1				07/23/2018	2019.01	07/23/2018 12:40:57 PM Eastern Daylight Time	08/02/2018 06:05:34 PM Eastern Daylight Time	08/02/2018 11:12:34 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential Clarity (HMO)	01	01		1			H5475	026	0	2019	Greater Detroit		2	12000	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	027	0	1	01	01	H5475_027_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 09:35:02 AM Eastern Daylight Time	08/02/2018 06:06:42 PM Eastern Daylight Time	08/02/2018 11:13:18 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Extra Smile (HMO SNP)	01	01		1			H5475	027	0	2019	Greater Cincinnati		2	1000	2			1	3		1		1	www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	028	0	1	01	01	H5475_028_0	8	1				07/23/2018	2019.01	07/23/2018 12:41:35 PM Eastern Daylight Time	08/02/2018 06:07:50 PM Eastern Daylight Time	08/02/2018 11:14:02 AM Eastern Daylight Time			08/07/2018 05:05:31 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential Smile (HMO)	01	01		1			H5475	028	0	2019	Greater Cincinnati		2	12000	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5493	001	0	1	20	08	H5493_001_0	1	1				06/01/2018	2019.01	06/01/2018 11:32:28 AM Eastern Daylight Time		06/01/2018 10:05:32 AM Eastern Daylight Time			06/01/2018 12:14:14 PM Eastern Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	Saint Francis LIFE	http://stfrancishealthcare.org/life/	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	001	0	2019	New Castle County, Delaware		2		2			2						www.stfrancishealthcare.org	www.stfrancishealthcare.org												(302)660-3355		(800)000-0000		(302)660-3351												(800)232-5460		(800)676-3777		(000)000-0000																
H5493	002	0	1	20	08	H5493_002_0	1	1				06/01/2018	2019.01	06/01/2018 11:32:50 AM Eastern Daylight Time		06/01/2018 10:05:04 AM Eastern Daylight Time			06/01/2018 12:14:14 PM Eastern Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	Saint Francis LIFE	http://stfrancishealthcare.org/life/	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	002	0	2019	LIFE at St. Francis Healthcare, Inc		2		2			2						www.stfrancishealthcare.org	www.stfrancishealthcare.org												(302)660-3355				(302)660-3351												(800)232-5460				(800)232-5460																
H5496	005	0	1	01	01	H5496_005_0	6	1		1		07/10/2018	2019.01	07/10/2018 09:41:57 AM Eastern Daylight Time	08/02/2018 12:11:20 PM Eastern Daylight Time	08/02/2018 12:15:37 PM Eastern Daylight Time			08/06/2018 11:03:49 AM Eastern Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Senior Value (HMO SNP)	01	01		1			H5496	005	0	2019	County: San Francisco & Los Angeles		2	6000	2			1	4			00000000000000000010		www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333	201	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5496	007	0	1	01	01	H5496_007_0	5	1				07/10/2018	2019.01	07/10/2018 09:43:10 AM Eastern Daylight Time	08/02/2018 12:12:30 PM Eastern Daylight Time	08/02/2018 12:16:54 PM Eastern Daylight Time			08/06/2018 11:03:49 AM Eastern Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Traditional (HMO)	01	01		1			H5496	007	0	2019	County: San Francisco & Los Angeles		2	12000	2			2						www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5496	009	0	1	01	01	H5496_009_0	5	1				08/01/2018	2019.01	08/01/2018 12:46:13 PM Eastern Daylight Time	08/02/2018 12:13:37 PM Eastern Daylight Time	08/02/2018 12:17:45 PM Eastern Daylight Time			08/06/2018 11:03:49 AM Eastern Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Traditional Plus (HMO)	01	01		1			H5496	009	0	2019	County: San Francisco & Los Angeles		2	6000	2			2						www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5521	012	0	1	04	01	H5521_012_0	5	1				07/11/2018	2019.01	07/11/2018 10:57:16 AM Eastern Daylight Time	08/02/2018 06:59:26 PM Eastern Daylight Time	07/31/2018 11:43:00 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	012	0	2019	Central and NE PA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	013	0	1	04	01	H5521_013_0	3	1				08/01/2018	2019.01	08/01/2018 04:03:14 PM Eastern Daylight Time	08/03/2018 10:15:46 AM Central Daylight Time	07/31/2018 10:11:26 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Complete (PPO)	01	04		1			H5521	013	0	2019	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	015	0	1	04	01	H5521_015_0	3	1				07/11/2018	2019.01	07/11/2018 10:58:15 AM Eastern Daylight Time	08/02/2018 12:12:22 PM Eastern Daylight Time	07/31/2018 11:43:54 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	015	0	2019	District of Columbia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	016	0	1	04	01	H5521_016_0	3	1				07/11/2018	2019.01	07/11/2018 10:45:22 AM Eastern Daylight Time	08/02/2018 02:11:00 PM Eastern Daylight Time	07/31/2018 05:58:52 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	016	0	2019	Chicagoland		2	21048	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	020	0	1	04	01	H5521_020_0	3	1				07/11/2018	2019.01	07/11/2018 10:58:50 AM Eastern Daylight Time	08/02/2018 03:04:19 PM Eastern Daylight Time	07/31/2018 11:44:48 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	020	0	2019	Ohio and Northern Kentucky		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	022	0	1	04	01	H5521_022_0	3	1				07/11/2018	2019.01	07/11/2018 10:45:51 AM Eastern Daylight Time	08/02/2018 03:05:22 PM Eastern Daylight Time	07/31/2018 05:59:34 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	022	0	2019	Clark County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	027	0	1	04	01	H5521_027_0	3	1				07/11/2018	2019.01	07/11/2018 10:59:18 AM Eastern Daylight Time	08/02/2018 12:13:25 PM Eastern Daylight Time	07/31/2018 11:45:42 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	027	0	2019	Fairfax County and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	033	0	1	04	01	H5521_033_0	3	1				08/02/2018	2019.01	08/02/2018 07:30:28 PM Eastern Daylight Time	08/03/2018 01:35:39 PM Eastern Daylight Time	07/31/2018 11:13:36 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	033	0	2019	North, Central, West, SW, Treasure Coast, South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	037	0	1	04	01	H5521_037_0	3	1				07/11/2018	2019.01	07/11/2018 09:11:10 AM Central Daylight Time	08/02/2018 03:54:29 PM Central Daylight Time	07/31/2018 10:12:18 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	037	0	2019	Northern New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	040	0	1	04	01	H5521_040_0	3	1				07/11/2018	2019.01	07/11/2018 09:12:34 AM Central Daylight Time	08/02/2018 09:29:45 AM Central Daylight Time	07/31/2018 10:13:10 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	040	0	2019	Metro (NYC, Queens, Brooklyn, SI, Nassau)		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	053	0	1	04	01	H5521_053_0	3	1				07/11/2018	2019.01	07/11/2018 10:46:17 AM Eastern Daylight Time	08/03/2018 10:03:05 AM Eastern Daylight Time	07/31/2018 06:00:15 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	053	0	2019	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	055	0	1	04	01	H5521_055_0	3	1				08/02/2018	2019.01	08/02/2018 07:21:56 AM Pacific Daylight Time	08/02/2018 03:06:45 PM Eastern Daylight Time	07/31/2018 06:00:55 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	055	0	2019	Clark County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	056	0	1	04	01	H5521_056_0	3	1				07/11/2018	2019.01	07/11/2018 10:47:15 AM Eastern Daylight Time	08/03/2018 10:05:27 AM Eastern Daylight Time	07/31/2018 06:01:36 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	056	0	2019	Orange County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	057	0	1	04	01	H5521_057_0	3	1				07/11/2018	2019.01	07/11/2018 10:47:41 AM Eastern Daylight Time	08/02/2018 03:06:14 PM Eastern Daylight Time	07/31/2018 06:02:15 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (PPO)	01	04		1			H5521	057	0	2019	Denver and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	058	0	1	04	01	H5521_058_0	3	1				08/02/2018	2019.01	08/02/2018 10:36:23 AM Central Daylight Time	08/02/2018 04:15:15 PM Eastern Daylight Time	07/31/2018 11:14:26 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	058	0	2019	South Central Texas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	059	0	1	04	01	H5521_059_0	3	1				08/03/2018	2019.01	08/03/2018 08:25:55 AM Central Daylight Time	08/02/2018 04:15:57 PM Eastern Daylight Time	07/31/2018 11:15:18 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	059	0	2019	North Central Texas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	060	0	1	04	01	H5521_060_0	3	1				08/02/2018	2019.01	08/02/2018 10:38:36 AM Central Daylight Time	08/02/2018 04:16:37 PM Eastern Daylight Time	07/31/2018 11:16:10 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	060	0	2019	Southeast Texas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	076	0	1	04	01	H5521_076_0	3	1				07/18/2018	2019.01	07/18/2018 06:26:38 PM Eastern Daylight Time	08/02/2018 09:31:07 AM Central Daylight Time	07/31/2018 10:14:08 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	076	0	2019	Greater Rochester		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	077	0	1	04	01	H5521_077_0	3	1				08/02/2018	2019.01	08/02/2018 11:53:00 AM Eastern Daylight Time	08/02/2018 09:32:22 AM Central Daylight Time	07/31/2018 10:15:00 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	077	0	2019	Northern Central Upstate NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	081	0	1	04	01	H5521_081_0	3	1				08/02/2018	2019.01	08/02/2018 10:59:31 AM Eastern Daylight Time	08/02/2018 12:35:44 PM Eastern Daylight Time	07/31/2018 11:17:00 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	081	0	2019	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	082	0	1	04	01	H5521_082_0	3	1				07/11/2018	2019.01	07/11/2018 11:00:06 AM Eastern Daylight Time	08/02/2018 12:14:26 PM Eastern Daylight Time	07/31/2018 11:46:38 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	082	0	2019	Richmond and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	083	0	1	04	01	H5521_083_0	3	1				07/11/2018	2019.01	07/11/2018 11:00:40 AM Eastern Daylight Time	08/02/2018 12:15:24 PM Eastern Daylight Time	07/31/2018 11:47:32 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	083	0	2019	Danville City and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	084	0	1	04	01	H5521_084_0	3	1				07/11/2018	2019.01	07/11/2018 11:01:05 AM Eastern Daylight Time	08/02/2018 12:16:22 PM Eastern Daylight Time	07/31/2018 11:48:22 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	084	0	2019	Newport News and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	085	0	1	04	01	H5521_085_0	3	1				08/03/2018	2019.01	08/03/2018 12:53:24 PM Eastern Daylight Time	08/02/2018 03:04:54 PM Eastern Daylight Time	07/31/2018 11:49:18 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	085	0	2019	Northern KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	086	0	1	04	01	H5521_086_0	3	1				08/02/2018	2019.01	08/02/2018 10:14:17 AM Eastern Daylight Time	08/02/2018 02:11:38 PM Eastern Daylight Time	07/31/2018 06:02:57 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	086	0	2019	Chicagoland		2	123264	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	087	0	1	04	01	H5521_087_0	3	1				08/03/2018	2019.01	08/03/2018 12:54:08 PM Eastern Daylight Time	08/02/2018 03:05:29 PM Eastern Daylight Time	07/31/2018 11:50:10 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	087	0	2019	Cincinnati OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	088	0	1	04	01	H5521_088_0	3	1				08/02/2018	2019.01	08/02/2018 11:09:24 AM Eastern Daylight Time	08/02/2018 03:06:05 PM Eastern Daylight Time	07/31/2018 11:51:02 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	088	0	2019	Toledo and Akron OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	089	0	1	04	01	H5521_089_0	3	1				08/02/2018	2019.01	08/02/2018 11:10:09 AM Eastern Daylight Time	08/02/2018 03:06:40 PM Eastern Daylight Time	07/31/2018 11:51:54 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	089	0	2019	Central OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	090	0	1	04	01	H5521_090_0	3	1				08/02/2018	2019.01	08/02/2018 11:10:23 AM Eastern Daylight Time	08/02/2018 03:07:14 PM Eastern Daylight Time	07/31/2018 11:52:46 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	090	0	2019	Dayton OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	091	0	1	04	01	H5521_091_0	3	1				08/02/2018	2019.01	08/02/2018 07:40:37 PM Eastern Daylight Time	08/02/2018 11:47:50 AM Eastern Daylight Time	07/31/2018 11:17:50 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	091	0	2019	Select Georgia and Alabama Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	092	0	1	04	01	H5521_092_0	3	1				07/11/2018	2019.01	07/11/2018 10:35:44 AM Eastern Daylight Time	08/02/2018 04:17:16 PM Eastern Daylight Time	07/31/2018 11:18:44 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	092	0	2019	South Central Texas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	094	0	1	04	01	H5521_094_0	3	1				07/11/2018	2019.01	07/11/2018 10:36:27 AM Eastern Daylight Time	08/02/2018 04:17:56 PM Eastern Daylight Time	07/31/2018 11:19:36 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	094	0	2019	Southeast Texas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	095	0	1	04	01	H5521_095_0	3	1				07/11/2018	2019.01	07/11/2018 11:04:17 AM Eastern Daylight Time	08/02/2018 06:58:27 PM Eastern Daylight Time	07/31/2018 11:53:40 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	095	0	2019	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	099	0	1	04	01	H5521_099_0	3	1				08/02/2018	2019.01	08/02/2018 10:14:56 AM Eastern Daylight Time	08/02/2018 02:12:16 PM Eastern Daylight Time	07/31/2018 06:03:39 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	099	0	2019	Fort Wayne Metropolitan Area		2	38964	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	100	0	1	04	01	H5521_100_0	3	1				08/01/2018	2019.01	08/01/2018 01:23:33 PM Pacific Daylight Time	08/02/2018 03:37:32 PM Eastern Daylight Time	07/31/2018 06:04:20 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	100	0	2019	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	101	0	1	04	01	H5521_101_0	3	1				07/11/2018	2019.01	07/11/2018 10:49:02 AM Eastern Daylight Time	08/02/2018 02:14:27 PM Eastern Daylight Time	07/31/2018 06:05:00 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	101	0	2019	Salt Lake and Utah counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	102	0	1	04	01	H5521_102_0	3	1				07/11/2018	2019.01	07/11/2018 11:04:45 AM Eastern Daylight Time	08/02/2018 12:17:23 PM Eastern Daylight Time	07/31/2018 11:54:34 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	102	0	2019	Roanoke and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	103	0	1	04	01	H5521_103_0	3	1				08/02/2018	2019.01	08/02/2018 10:39:24 AM Central Daylight Time	08/02/2018 04:18:34 PM Eastern Daylight Time	07/31/2018 11:20:26 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	103	0	2019	Austin and surrounding counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	104	0	1	04	01	H5521_104_0	3	1				08/02/2018	2019.01	08/02/2018 10:39:45 AM Central Daylight Time	08/02/2018 04:19:17 PM Eastern Daylight Time	07/31/2018 11:21:16 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	104	0	2019	South Texas Non Metro counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	105	0	1	04	01	H5521_105_0	3	1				08/02/2018	2019.01	08/02/2018 10:40:09 AM Central Daylight Time	08/02/2018 04:19:57 PM Eastern Daylight Time	07/31/2018 11:22:06 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	105	0	2019	Corpus Christi and surrounding counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	107	0	1	04	01	H5521_107_0	3	1				08/02/2018	2019.01	08/02/2018 10:40:57 AM Central Daylight Time	08/02/2018 04:20:37 PM Eastern Daylight Time	07/31/2018 11:22:56 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	107	0	2019	El Paso County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	108	0	1	04	01	H5521_108_0	3	1				07/11/2018	2019.01	07/11/2018 10:39:54 AM Eastern Daylight Time	08/02/2018 04:21:20 PM Eastern Daylight Time	07/31/2018 11:23:54 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	108	0	2019	North Central Texas counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	109	0	1	04	01	H5521_109_0	3	1				08/02/2018	2019.01	08/02/2018 10:45:08 AM Central Daylight Time	08/02/2018 04:22:03 PM Eastern Daylight Time	07/31/2018 11:24:48 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	109	0	2019	North Texas Non Metro counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	110	0	1	04	01	H5521_110_0	3	1				07/11/2018	2019.01	07/11/2018 11:45:58 AM Central Daylight Time	08/02/2018 09:33:32 AM Central Daylight Time	07/31/2018 10:15:54 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	110	0	2019	Capital Region and Hudson Valley		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	114	0	1	04	01	H5521_114_0	3	1				08/01/2018	2019.01	08/01/2018 02:16:15 PM Eastern Daylight Time	08/02/2018 11:48:33 AM Eastern Daylight Time	07/31/2018 11:25:40 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	114	0	2019	Select Georgia counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	115	0	1	04	01	H5521_115_0	3	1				07/11/2018	2019.01	07/11/2018 10:41:39 AM Eastern Daylight Time	08/02/2018 11:49:16 AM Eastern Daylight Time	07/31/2018 11:26:32 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	01	04		1			H5521	115	0	2019	Select Georgia counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	116	0	1	04	01	H5521_116_0	3	1				08/01/2018	2019.01	08/01/2018 02:18:29 PM Eastern Daylight Time	08/02/2018 11:49:58 AM Eastern Daylight Time	07/31/2018 11:27:24 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	116	0	2019	Southwest Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	117	0	1	04	01	H5521_117_0	3	1				07/11/2018	2019.01	07/11/2018 06:55:06 PM Central Daylight Time	08/02/2018 09:38:27 AM Central Daylight Time	07/31/2018 10:16:46 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	117	0	2019	Suffolk County		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	118	0	1	04	01	H5521_118_0	3	1				08/02/2018	2019.01	08/02/2018 11:57:36 AM Eastern Daylight Time	08/02/2018 09:40:54 AM Central Daylight Time	07/31/2018 10:17:38 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	118	0	2019	Greater Rochester		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	119	0	1	04	01	H5521_119_0	3	1				07/11/2018	2019.01	07/11/2018 09:19:09 AM Central Daylight Time	08/02/2018 09:42:41 AM Central Daylight Time	07/31/2018 10:18:32 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	119	0	2019	Capital Region and Hudson Valley		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	120	0	1	04	01	H5521_120_0	3	1				08/02/2018	2019.01	08/02/2018 11:59:35 AM Eastern Daylight Time	08/02/2018 09:43:46 AM Central Daylight Time	07/31/2018 10:19:24 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	120	0	2019	Metro (LI, 5 Boroughs, Westchester/Rockland)		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	121	0	1	04	01	H5521_121_0	3	1				07/11/2018	2019.01	07/11/2018 09:19:42 AM Central Daylight Time	08/02/2018 09:44:50 AM Central Daylight Time	07/31/2018 10:20:18 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	121	0	2019	Westchester, Rockland, Bronx		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	122	0	1	04	01	H5521_122_0	3	1				07/11/2018	2019.01	07/11/2018 11:05:18 AM Eastern Daylight Time	08/02/2018 06:57:27 PM Eastern Daylight Time	07/31/2018 11:55:26 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Plan (PPO)	01	04		1			H5521	122	0	2019	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	123	0	1	04	01	H5521_123_0	4	1				07/11/2018	2019.01	07/11/2018 09:20:45 AM Central Daylight Time	08/02/2018 03:55:06 PM Central Daylight Time	07/31/2018 10:21:10 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare SNJ Prime Elite Plan (PPO)	01	04		1			H5521	123	0	2019	Counties: Burlington, Camden, Gloucester, Mercer		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	124	0	1	04	01	H5521_124_0	3	1				07/11/2018	2019.01	07/11/2018 09:21:00 AM Central Daylight Time	08/02/2018 03:56:05 PM Central Daylight Time	07/31/2018 10:22:04 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	124	0	2019	Counties: ATL, BUR, CAM, CPM, CUM, GLO, SLM		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	125	0	1	04	01	H5521_125_0	3	1				07/11/2018	2019.01	07/11/2018 10:49:20 AM Eastern Daylight Time	08/03/2018 10:07:13 AM Eastern Daylight Time	07/31/2018 06:05:41 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	125	0	2019	Los Angeles County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	126	0	1	04	01	H5521_126_0	3	1				07/11/2018	2019.01	07/11/2018 10:49:39 AM Eastern Daylight Time	08/03/2018 10:08:29 AM Eastern Daylight Time	07/31/2018 06:06:21 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	126	0	2019	Riverside and San Bernardino counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	127	0	1	04	01	H5521_127_0	3	1				07/11/2018	2019.01	07/11/2018 10:50:05 AM Eastern Daylight Time	08/01/2018 03:07:55 PM Eastern Daylight Time	07/31/2018 06:07:01 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	127	0	2019	Greater Seattle Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	128	0	1	04	01	H5521_128_0	3	1				07/11/2018	2019.01	07/11/2018 10:50:25 AM Eastern Daylight Time	08/01/2018 03:08:52 PM Eastern Daylight Time	07/31/2018 06:07:41 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	128	0	2019	Greater Seattle Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	130	0	1	04	01	H5521_130_0	3	1				07/11/2018	2019.01	07/11/2018 03:10:46 PM Eastern Daylight Time	08/02/2018 03:09:26 PM Eastern Daylight Time	07/31/2018 06:08:22 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	130	0	2019	Washoe, Carson City and Douglas County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	131	0	1	04	01	H5521_131_0	3	1				07/11/2018	2019.01	07/11/2018 10:51:06 AM Eastern Daylight Time	08/02/2018 02:01:27 PM Eastern Daylight Time	07/31/2018 06:09:02 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	131	0	2019	Northeast Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	134	0	1	04	01	H5521_134_0	3	1				07/11/2018	2019.01	07/11/2018 11:05:56 AM Eastern Daylight Time	08/02/2018 03:07:51 PM Eastern Daylight Time	07/31/2018 11:56:16 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	134	0	2019	Select Counties in Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	139	0	1	04	01	H5521_139_0	3	1				08/02/2018	2019.01	08/02/2018 11:07:25 AM Eastern Daylight Time	08/02/2018 12:38:13 PM Eastern Daylight Time	07/31/2018 11:28:16 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	139	0	2019	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	140	0	1	04	01	H5521_140_0	3	1				08/02/2018	2019.01	08/02/2018 11:33:41 AM Eastern Daylight Time	08/02/2018 12:40:08 PM Eastern Daylight Time	07/31/2018 11:29:10 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	140	0	2019	Greenville/Spartanburg and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	141	0	1	04	01	H5521_141_0	3	1				08/02/2018	2019.01	08/02/2018 11:22:04 AM Eastern Daylight Time	08/02/2018 12:41:54 PM Eastern Daylight Time	07/31/2018 11:29:58 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	141	0	2019	Nashville and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	142	0	1	04	01	H5521_142_0	3	1				07/11/2018	2019.01	07/11/2018 09:21:58 AM Central Daylight Time	08/03/2018 10:16:28 AM Central Daylight Time	07/31/2018 10:22:56 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	142	0	2019	Southern Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	143	0	1	04	01	H5521_143_0	3	1				07/11/2018	2019.01	07/11/2018 09:22:13 AM Central Daylight Time	08/03/2018 10:17:10 AM Central Daylight Time	07/31/2018 10:23:48 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	143	0	2019	Mid Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	144	0	1	04	01	H5521_144_0	3	1				07/11/2018	2019.01	07/11/2018 09:22:30 AM Central Daylight Time	08/03/2018 10:17:50 AM Central Daylight Time	07/31/2018 10:24:46 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	144	0	2019	Northern and Additional Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	145	0	1	04	01	H5521_145_0	3	1				08/02/2018	2019.01	08/02/2018 10:47:27 AM Central Daylight Time	08/02/2018 04:22:44 PM Eastern Daylight Time	07/31/2018 11:30:48 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	145	0	2019	Rio Grande Valley and Laredo		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	146	0	1	04	01	H5521_146_0	3	1				07/11/2018	2019.01	07/11/2018 10:50:30 AM Eastern Daylight Time	08/02/2018 04:23:23 PM Eastern Daylight Time	07/31/2018 11:31:42 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H5521	146	0	2019	El Paso county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	147	0	1	04	01	H5521_147_0	3	1				08/02/2018	2019.01	08/02/2018 11:06:04 AM Central Daylight Time	08/02/2018 04:24:03 PM Eastern Daylight Time	07/31/2018 11:32:30 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	147	0	2019	Panhandle Region		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	148	0	1	04	01	H5521_148_0	3	1				07/11/2018	2019.01	07/11/2018 10:51:30 AM Eastern Daylight Time	08/02/2018 02:12:53 PM Eastern Daylight Time	07/31/2018 06:09:41 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	148	0	2019	Midland/Grand Rapids Metro		2	4452	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	149	0	1	04	01	H5521_149_0	3	1				07/11/2018	2019.01	07/11/2018 10:51:50 AM Eastern Daylight Time	08/02/2018 02:13:32 PM Eastern Daylight Time	07/31/2018 06:10:22 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	149	0	2019	Detroit Metropolitan Area		2	19284	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	150	0	1	04	01	H5521_150_0	3	1				07/11/2018	2019.01	07/11/2018 10:52:10 AM Eastern Daylight Time	08/02/2018 02:14:11 PM Eastern Daylight Time	07/31/2018 06:11:02 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	150	0	2019	Milwaukee Metropolitan Area		2	14688	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	151	0	1	04	01	H5521_151_0	3	1				07/11/2018	2019.01	07/11/2018 10:52:35 AM Eastern Daylight Time	08/02/2018 02:14:50 PM Eastern Daylight Time	07/31/2018 06:11:44 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	151	0	2019	Central Indiana		2	6564	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	152	0	1	04	01	H5521_152_0	3	1				07/11/2018	2019.01	07/11/2018 10:52:57 AM Eastern Daylight Time	08/02/2018 02:15:26 PM Eastern Daylight Time	07/31/2018 06:12:27 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	152	0	2019	Southwest Indiana		2	1596	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	153	0	1	04	01	H5521_153_0	3	1				07/11/2018	2019.01	07/11/2018 10:53:18 AM Eastern Daylight Time	08/02/2018 02:16:02 PM Eastern Daylight Time	07/31/2018 06:13:07 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	153	0	2019	Kankakee county IL		2	2184	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	154	0	1	04	01	H5521_154_0	3	1				08/02/2018	2019.01	08/02/2018 11:22:44 AM Eastern Daylight Time	08/02/2018 12:44:06 PM Eastern Daylight Time	07/31/2018 11:33:24 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	154	0	2019	Memphis and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	156	0	1	04	01	H5521_156_0	3	1				08/02/2018	2019.01	08/02/2018 11:10:50 AM Eastern Daylight Time	08/02/2018 03:08:27 PM Eastern Daylight Time	07/31/2018 11:57:08 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	156	0	2019	Lexington KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	157	0	1	04	01	H5521_157_0	3	1				08/03/2018	2019.01	08/03/2018 09:01:44 AM Eastern Daylight Time	08/03/2018 10:18:34 AM Central Daylight Time	07/31/2018 10:25:38 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	157	0	2019	Connecticut		2	3369	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	159	0	1	04	01	H5521_159_0	3	1				08/03/2018	2019.01	08/03/2018 09:02:47 AM Eastern Daylight Time	08/03/2018 10:19:14 AM Central Daylight Time	07/31/2018 10:26:30 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	159	0	2019	Eastern MA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	160	0	1	04	01	H5521_160_0	3	1				08/03/2018	2019.01	08/03/2018 09:03:22 AM Eastern Daylight Time	08/03/2018 10:19:55 AM Central Daylight Time	07/31/2018 10:27:24 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	160	0	2019	Central MA		2	3369	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	167	0	1	04	01	H5521_167_0	3	1				08/02/2018	2019.01	08/02/2018 10:51:15 AM Central Daylight Time	08/02/2018 04:24:46 PM Eastern Daylight Time	07/31/2018 11:34:18 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H5521	167	0	2019	Cameron, Hidalgo, Starr, Nueces and Webb Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	168	0	1	04	01	H5521_168_0	3	1				08/02/2018	2019.01	08/02/2018 11:09:20 AM Eastern Daylight Time	08/02/2018 12:45:51 PM Eastern Daylight Time	07/31/2018 11:35:14 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	168	0	2019	Wake, Durham Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	169	0	1	04	01	H5521_169_0	3	1				07/11/2018	2019.01	07/11/2018 10:55:38 AM Eastern Daylight Time	08/02/2018 12:47:32 PM Eastern Daylight Time	07/31/2018 11:36:04 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	169	0	2019	Fayetteville and Sandhills Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	170	0	1	04	01	H5521_170_0	3	1				08/02/2018	2019.01	08/02/2018 11:13:29 AM Eastern Daylight Time	08/02/2018 12:49:18 PM Eastern Daylight Time	07/31/2018 11:36:56 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	01	04		1			H5521	170	0	2019	Greensboro, Winston-Salem and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	171	0	1	04	01	H5521_171_0	3	1				08/01/2018	2019.01	08/01/2018 02:19:57 PM Eastern Daylight Time	08/02/2018 11:50:39 AM Eastern Daylight Time	07/31/2018 11:37:50 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	171	0	2019	Central Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	177	0	1	04	01	H5521_177_0	3	1				07/11/2018	2019.01	07/11/2018 10:57:24 AM Eastern Daylight Time	08/02/2018 11:51:20 AM Eastern Daylight Time	07/31/2018 11:38:44 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	177	0	2019	Cherokee County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	178	0	1	04	01	H5521_178_0	3	1				08/01/2018	2019.01	08/01/2018 02:21:31 PM Eastern Daylight Time	08/02/2018 11:52:01 AM Eastern Daylight Time	07/31/2018 11:39:34 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	178	0	2019	Select Louisiana Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	179	0	1	04	01	H5521_179_0	2	1				07/11/2018	2019.01	07/11/2018 11:06:23 AM Eastern Daylight Time	05/28/2018 01:54:38 PM Eastern Daylight Time				07/11/2018 09:51:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basics Plan (PPO)	01	04		1			H5521	179	0	2019	Select Georgia Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	183	0	1	04	01	H5521_183_0	3	1				07/11/2018	2019.01	07/11/2018 11:06:58 AM Eastern Daylight Time	08/02/2018 12:51:12 PM Eastern Daylight Time	07/31/2018 11:40:28 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	183	0	2019	Wake, Durham Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	184	0	1	04	01	H5521_184_0	3	1				07/11/2018	2019.01	07/11/2018 10:53:40 AM Eastern Daylight Time	08/02/2018 03:34:36 PM Eastern Daylight Time	07/31/2018 06:13:47 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	184	0	2019	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	185	0	1	04	01	H5521_185_0	3	1				08/01/2018	2019.01	08/01/2018 01:24:55 PM Pacific Daylight Time	08/02/2018 03:32:38 PM Eastern Daylight Time	07/31/2018 06:14:27 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	185	0	2019	Pima and Pinal Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	186	0	1	04	01	H5521_186_0	3	1				07/11/2018	2019.01	07/11/2018 10:54:23 AM Eastern Daylight Time	08/02/2018 03:31:20 PM Eastern Daylight Time	07/31/2018 06:15:10 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	186	0	2019	Pima and Pinal Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	187	0	1	04	01	H5521_187_0	3	1				07/11/2018	2019.01	07/11/2018 10:54:46 AM Eastern Daylight Time	08/02/2018 03:07:17 PM Eastern Daylight Time	07/31/2018 06:15:50 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	187	0	2019	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	190	0	1	04	01	H5521_190_0	3	1				07/11/2018	2019.01	07/11/2018 10:55:07 AM Eastern Daylight Time	08/02/2018 02:16:39 PM Eastern Daylight Time	07/31/2018 06:16:34 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	190	0	2019	Fort Wayne Metropolitan Area		2	612	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	194	0	1	04	01	H5521_194_0	3	1				07/11/2018	2019.01	07/11/2018 10:55:33 AM Eastern Daylight Time	08/02/2018 02:17:17 PM Eastern Daylight Time	07/31/2018 06:17:15 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	194	0	2019	Midland/Grand Rapids Metro		2	3756	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	195	0	1	04	01	H5521_195_0	3	1				08/01/2018	2019.01	08/01/2018 05:04:22 PM Eastern Daylight Time	08/02/2018 02:17:55 PM Eastern Daylight Time	07/31/2018 06:17:55 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	195	0	2019	Milwaukee Metropolitan Area		2	11652	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	196	0	1	04	01	H5521_196_0	3	1				07/11/2018	2019.01	07/11/2018 10:56:23 AM Eastern Daylight Time	08/02/2018 02:02:04 PM Eastern Daylight Time	07/31/2018 06:18:41 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	196	0	2019	Southern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	197	0	1	04	01	H5521_197_0	3	1				07/11/2018	2019.01	07/11/2018 10:56:41 AM Eastern Daylight Time	08/02/2018 02:02:42 PM Eastern Daylight Time	07/31/2018 06:19:21 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	197	0	2019	Davis, Weber and surrounding counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	199	0	1	04	01	H5521_199_0	3	1				08/02/2018	2019.01	08/02/2018 10:58:51 AM Central Daylight Time	08/02/2018 04:25:26 PM Eastern Daylight Time	07/31/2018 11:41:22 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H5521	199	0	2019	Bexar, Travis, and Williamson Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	200	0	1	04	01	H5521_200_0	3	1				07/11/2018	2019.01	07/11/2018 10:57:02 AM Eastern Daylight Time	08/02/2018 03:25:55 PM Eastern Daylight Time	07/31/2018 06:19:59 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	200	0	2019	Mohave, Yuma, Yavapai and Gila Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	201	0	1	04	01	H5521_201_0	3	1				08/01/2018	2019.01	08/01/2018 01:16:38 PM Pacific Daylight Time	08/02/2018 03:11:46 PM Eastern Daylight Time	07/31/2018 06:20:38 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	201	0	2019	Carson City, Washoe and Douglas Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	202	0	1	04	01	H5521_202_0	3	1				08/02/2018	2019.01	08/02/2018 10:59:14 AM Central Daylight Time	08/02/2018 04:26:08 PM Eastern Daylight Time	07/31/2018 11:42:16 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H5521	202	0	2019	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	203	0	1	04	01	H5521_203_0	3	1				08/02/2018	2019.01	08/02/2018 10:59:47 AM Central Daylight Time	08/02/2018 04:26:47 PM Eastern Daylight Time	07/31/2018 11:43:10 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H5521	203	0	2019	Dallas County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	204	0	1	04	01	H5521_204_0	3	1				07/11/2018	2019.01	07/11/2018 11:09:12 AM Eastern Daylight Time	08/02/2018 04:27:28 PM Eastern Daylight Time	07/31/2018 11:44:02 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	204	0	2019	Panhandle Region		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	205	0	1	04	01	H5521_205_0	3	1				07/11/2018	2019.01	07/11/2018 10:57:44 AM Eastern Daylight Time	08/03/2018 10:10:32 AM Eastern Daylight Time	07/31/2018 06:21:19 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	205	0	2019	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	206	0	1	04	01	H5521_206_0	3	1				07/11/2018	2019.01	07/11/2018 10:58:03 AM Eastern Daylight Time	08/03/2018 10:11:18 AM Eastern Daylight Time	07/31/2018 06:22:00 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	206	0	2019	Fresno County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	207	0	1	04	01	H5521_207_0	3	1				08/01/2018	2019.01	08/01/2018 03:59:19 PM Central Daylight Time	08/02/2018 03:08:10 PM Eastern Daylight Time	07/31/2018 06:22:39 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Essential Plan (PPO)	01	04		1			H5521	207	0	2019	Southern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	208	0	1	04	01	H5521_208_0	3	1				07/11/2018	2019.01	07/11/2018 10:58:58 AM Eastern Daylight Time	08/02/2018 03:09:00 PM Eastern Daylight Time	07/31/2018 06:23:18 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (PPO)	01	04		1			H5521	208	0	2019	Northern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	211	0	1	04	01	H5521_211_0	3	1				08/01/2018	2019.01	08/01/2018 05:04:46 PM Eastern Daylight Time	08/02/2018 02:18:34 PM Eastern Daylight Time	07/31/2018 06:23:55 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	211	0	2019	Southwest Indiana		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	212	0	1	04	01	H5521_212_0	3	1				07/11/2018	2019.01	07/11/2018 09:25:26 AM Central Daylight Time	08/02/2018 09:45:55 AM Central Daylight Time	07/31/2018 10:28:18 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	212	0	2019	Western NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	213	0	1	04	01	H5521_213_0	3	1				08/02/2018	2019.01	08/02/2018 07:41:24 PM Eastern Daylight Time	08/02/2018 11:52:42 AM Eastern Daylight Time	07/31/2018 11:44:52 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	213	0	2019	Hall County		2	200	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	214	0	1	04	01	H5521_214_0	3	1				08/02/2018	2019.01	08/02/2018 10:15:32 AM Eastern Daylight Time	08/02/2018 02:19:12 PM Eastern Daylight Time	07/31/2018 06:24:35 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	214	0	2019	Detroit Metropolitan Area		2	540	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	215	0	1	04	01	H5521_215_0	3	1				07/11/2018	2019.01	07/11/2018 09:25:52 AM Central Daylight Time	08/02/2018 09:47:27 AM Central Daylight Time	07/31/2018 10:29:10 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	215	0	2019	Western NY		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	216	0	1	04	01	H5521_216_0	3	1				08/01/2018	2019.01	08/01/2018 02:23:13 PM Eastern Daylight Time	08/02/2018 11:53:24 AM Eastern Daylight Time	07/31/2018 11:45:46 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	216	0	2019	Tuscaloosa and Surrounding Counties		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	217	0	1	04	01	H5521_217_0	3	1				07/11/2018	2019.01	07/11/2018 11:00:07 AM Eastern Daylight Time	08/02/2018 02:19:53 PM Eastern Daylight Time	07/31/2018 06:25:16 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	217	0	2019	Detroit Metropolitan Area		2	456	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	218	0	1	04	01	H5521_218_0	3	1				08/01/2018	2019.01	08/01/2018 02:25:10 PM Eastern Daylight Time	08/02/2018 11:54:06 AM Eastern Daylight Time	07/31/2018 11:46:40 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	218	0	2019	Northern Mississippi		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	219	0	1	04	01	H5521_219_0	3	1				08/02/2018	2019.01	08/02/2018 10:16:02 AM Eastern Daylight Time	08/02/2018 02:20:32 PM Eastern Daylight Time	07/31/2018 06:25:55 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	219	0	2019	Midland/Grand Rapids Metro		2	276	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	220	0	1	04	01	H5521_220_0	3	1				08/01/2018	2019.01	08/01/2018 02:26:27 PM Eastern Daylight Time	08/02/2018 11:54:49 AM Eastern Daylight Time	07/31/2018 11:47:36 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	220	0	2019	Southern Mississippi		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	221	0	1	04	01	H5521_221_0	3	1				07/11/2018	2019.01	07/11/2018 09:26:41 AM Central Daylight Time	08/03/2018 10:20:36 AM Central Daylight Time	07/31/2018 10:30:02 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Complete (PPO)	01	04		1			H5521	221	0	2019	Eastern MA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	222	0	1	04	01	H5521_222_0	3	1				08/01/2018	2019.01	08/01/2018 02:27:43 PM Eastern Daylight Time	08/02/2018 11:55:35 AM Eastern Daylight Time	07/31/2018 11:48:26 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	222	0	2019	Southeast Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	223	0	1	04	01	H5521_223_0	3	1				08/01/2018	2019.01	08/01/2018 05:07:29 PM Eastern Daylight Time	08/02/2018 02:21:11 PM Eastern Daylight Time	07/31/2018 06:26:38 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	223	0	2019	NWIN		2	1464	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	224	0	1	04	01	H5521_224_0	3	1				08/01/2018	2019.01	08/01/2018 02:28:49 PM Eastern Daylight Time	08/02/2018 11:56:17 AM Eastern Daylight Time	07/31/2018 11:49:48 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	224	0	2019	Montgomery and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	225	0	1	04	01	H5521_225_0	3	1				07/11/2018	2019.01	07/11/2018 09:27:19 AM Central Daylight Time	08/03/2018 10:21:16 AM Central Daylight Time	07/31/2018 10:30:54 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Complete (PPO)	01	04		1			H5521	225	0	2019	Central MA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	226	0	1	04	01	H5521_226_0	3	1				07/11/2018	2019.01	07/11/2018 11:01:19 AM Eastern Daylight Time	08/02/2018 02:21:49 PM Eastern Daylight Time	07/31/2018 06:27:17 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	226	0	2019	NWIN		2	1524	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	227	0	1	04	01	H5521_227_0	3	1				08/01/2018	2019.01	08/01/2018 02:30:02 PM Eastern Daylight Time	08/02/2018 11:57:03 AM Eastern Daylight Time	07/31/2018 11:51:08 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	227	0	2019	Northern Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	228	0	1	04	01	H5521_228_0	3	1				08/01/2018	2019.01	08/01/2018 05:07:53 PM Eastern Daylight Time	08/02/2018 02:22:28 PM Eastern Daylight Time	07/31/2018 06:27:58 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	228	0	2019	Northern IL		2	1740	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	229	0	1	04	01	H5521_229_0	2	1				07/11/2018	2019.01	07/11/2018 11:12:42 AM Eastern Daylight Time	05/25/2018 04:28:01 PM Eastern Daylight Time				07/11/2018 09:51:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basics Plan (PPO)	01	04		1			H5521	229	0	2019	Select Alabama Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	230	0	1	04	01	H5521_230_0	3	1				08/01/2018	2019.01	08/01/2018 02:31:18 PM Eastern Daylight Time	08/02/2018 11:57:47 AM Eastern Daylight Time	07/31/2018 11:52:30 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	230	0	2019	Monroe Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	231	0	1	04	01	H5521_231_0	3	1				08/01/2018	2019.01	08/01/2018 05:08:38 PM Eastern Daylight Time	08/02/2018 02:23:06 PM Eastern Daylight Time	07/31/2018 06:28:38 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	231	0	2019	Central Indiana		2	1668	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	232	0	1	04	01	H5521_232_0	3	1				08/01/2018	2019.01	08/01/2018 02:32:26 PM Eastern Daylight Time	08/02/2018 11:58:28 AM Eastern Daylight Time	07/31/2018 11:53:52 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	232	0	2019	Alexandria Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	233	0	1	04	01	H5521_233_0	3	1				08/01/2018	2019.01	08/01/2018 02:50:44 PM Eastern Daylight Time	08/02/2018 11:59:10 AM Eastern Daylight Time	07/31/2018 11:55:00 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	233	0	2019	Lake Charles Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	234	0	1	04	01	H5521_234_0	3	1				08/01/2018	2019.01	08/01/2018 02:52:06 PM Eastern Daylight Time	08/02/2018 11:59:52 AM Eastern Daylight Time	07/31/2018 11:55:48 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	234	0	2019	Lafayette Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	235	0	1	04	01	H5521_235_0	2	1				07/11/2018	2019.01	07/11/2018 11:19:33 AM Eastern Daylight Time	05/25/2018 04:31:29 PM Eastern Daylight Time				07/11/2018 09:51:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basics Plan (PPO)	01	04		1			H5521	235	0	2019	Select Louisiana Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	236	0	1	04	01	H5521_236_0	3	1				08/02/2018	2019.01	08/02/2018 11:14:55 AM Eastern Daylight Time	08/02/2018 12:52:56 PM Eastern Daylight Time	07/31/2018 11:56:38 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	236	0	2019	Western North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	237	0	1	04	01	H5521_237_0	3	1				07/11/2018	2019.01	07/11/2018 11:02:58 AM Eastern Daylight Time	08/01/2018 03:09:49 PM Eastern Daylight Time	07/31/2018 06:29:18 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	237	0	2019	Clark county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	239	0	1	04	01	H5521_239_0	3	1				07/11/2018	2019.01	07/11/2018 11:20:44 AM Eastern Daylight Time	08/02/2018 12:54:29 PM Eastern Daylight Time	07/31/2018 11:57:34 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	239	0	2019	Western North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	240	0	1	04	01	H5521_240_0	3	1				07/11/2018	2019.01	07/11/2018 11:03:19 AM Eastern Daylight Time	08/02/2018 02:03:19 PM Eastern Daylight Time	07/31/2018 06:30:00 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	240	0	2019	Daggett, Uintah (UT), Uinta (WY)		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	241	0	1	04	01	H5521_241_0	3	1				07/11/2018	2019.01	07/11/2018 11:21:33 AM Eastern Daylight Time	05/29/2018 03:24:52 PM Eastern Daylight Time				07/11/2018 09:51:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basics Plan (PPO)	01	04		1			H5521	241	0	2019	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	242	0	1	04	01	H5521_242_0	3	1				07/11/2018	2019.01	07/11/2018 11:03:41 AM Eastern Daylight Time	08/01/2018 03:10:48 PM Eastern Daylight Time	07/31/2018 06:30:41 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	242	0	2019	Spokane county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	243	0	1	04	01	H5521_243_0	3	1				07/11/2018	2019.01	07/11/2018 11:22:28 AM Eastern Daylight Time	08/02/2018 12:56:26 PM Eastern Daylight Time	07/31/2018 11:58:26 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	243	0	2019	Rocky Mount North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	244	0	1	04	01	H5521_244_0	3	1				07/11/2018	2019.01	07/11/2018 11:04:03 AM Eastern Daylight Time	08/01/2018 03:11:47 PM Eastern Daylight Time	07/31/2018 06:31:20 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	244	0	2019	Clark county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	245	0	1	04	01	H5521_245_0	3	1				08/02/2018	2019.01	08/02/2018 11:18:27 AM Eastern Daylight Time	08/02/2018 12:59:06 PM Eastern Daylight Time	07/31/2018 11:59:16 PM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	245	0	2019	Columbia Metro South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	246	0	1	04	01	H5521_246_0	3	1				08/02/2018	2019.01	08/02/2018 06:16:58 AM Central Daylight Time	08/02/2018 02:03:56 PM Eastern Daylight Time	07/31/2018 06:32:00 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	246	0	2019	Davis, Salt Lake and Weber counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	247	0	1	04	01	H5521_247_0	3	1				08/02/2018	2019.01	08/02/2018 11:19:39 AM Eastern Daylight Time	08/02/2018 01:01:18 PM Eastern Daylight Time	08/01/2018 12:00:08 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	247	0	2019	Charleston and Surrounding Area South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	248	0	1	04	01	H5521_248_0	3	1				08/02/2018	2019.01	08/02/2018 06:16:10 AM Central Daylight Time	08/02/2018 02:04:32 PM Eastern Daylight Time	07/31/2018 06:32:39 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	248	0	2019	Utah County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	249	0	1	04	01	H5521_249_0	3	1				08/02/2018	2019.01	08/02/2018 11:20:12 AM Eastern Daylight Time	08/02/2018 01:03:16 PM Eastern Daylight Time	08/01/2018 12:01:08 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	249	0	2019	Chesterfield, Dillon and Marlboro South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	250	0	1	04	01	H5521_250_0	3	1				08/01/2018	2019.01	08/01/2018 11:54:36 AM Central Daylight Time	08/02/2018 03:10:49 PM Eastern Daylight Time	07/31/2018 06:33:19 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Essential Plan (PPO)	01	04		1			H5521	250	0	2019	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	251	0	1	04	01	H5521_251_0	3	1				07/11/2018	2019.01	07/11/2018 11:24:29 AM Eastern Daylight Time	08/02/2018 01:04:56 PM Eastern Daylight Time	08/01/2018 12:02:04 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	251	0	2019	Midlands South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	252	0	1	04	01	H5521_252_0	3	1				07/11/2018	2019.01	07/11/2018 11:25:24 AM Eastern Daylight Time	08/02/2018 01:06:38 PM Eastern Daylight Time	08/01/2018 12:02:58 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	252	0	2019	Hilton Head, Augusta and Surrounding Area SC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	253	0	1	04	01	H5521_253_0	3	1				08/02/2018	2019.01	08/02/2018 11:20:52 AM Eastern Daylight Time	08/02/2018 01:08:26 PM Eastern Daylight Time	08/01/2018 12:03:54 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	253	0	2019	Hilton Head and Surrounding Area South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	254	0	1	04	01	H5521_254_0	3	1				08/02/2018	2019.01	08/02/2018 11:23:21 AM Eastern Daylight Time	08/02/2018 01:10:16 PM Eastern Daylight Time	08/01/2018 12:04:46 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	254	0	2019	Middle Tennessee		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	257	0	1	04	01	H5521_257_0	3	1				08/01/2018	2019.01	08/01/2018 02:53:22 PM Eastern Daylight Time	08/02/2018 12:00:38 PM Eastern Daylight Time	08/01/2018 12:05:40 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	257	0	2019	Augusta Metro and Surrounding Counties		2	200	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	258	0	1	04	01	H5521_258_0	3	1				08/01/2018	2019.01	08/01/2018 02:54:30 PM Eastern Daylight Time	08/02/2018 12:01:22 PM Eastern Daylight Time	08/01/2018 12:06:32 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	258	0	2019	Columbus Metro and Surrounding Counties		2	200	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	259	0	1	04	01	H5521_259_0	3	1				08/02/2018	2019.01	08/02/2018 11:11:10 AM Eastern Daylight Time	08/02/2018 03:09:01 PM Eastern Daylight Time	07/31/2018 11:58:02 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	259	0	2019	Louisville KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	260	0	1	04	01	H5521_260_0	3	1				08/02/2018	2019.01	08/02/2018 11:11:29 AM Eastern Daylight Time	08/02/2018 03:09:36 PM Eastern Daylight Time	07/31/2018 11:58:54 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	260	0	2019	Bowling Green/Southwest KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	261	0	1	04	01	H5521_261_0	4	1				08/01/2018	2019.01	08/01/2018 06:59:54 PM Eastern Daylight Time	08/02/2018 06:56:23 PM Eastern Daylight Time	07/31/2018 11:59:46 PM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver (PPO)	01	04		1			H5521	261	0	2019	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	262	0	1	04	01	H5521_262_0	4	1				08/01/2018	2019.01	08/01/2018 07:01:13 PM Eastern Daylight Time	08/02/2018 06:55:24 PM Eastern Daylight Time	08/01/2018 12:00:48 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver (PPO)	01	04		1			H5521	262	0	2019	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	263	0	1	04	01	H5521_263_0	4	1				08/02/2018	2019.01	08/02/2018 03:02:57 PM Eastern Daylight Time	08/02/2018 06:54:30 PM Eastern Daylight Time	08/01/2018 12:01:50 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver (PPO)	01	04		1			H5521	263	0	2019	Central and Eastern PA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	801	0	1	04	01	H5521_801_0	4	1				06/04/2018	2019.01	06/04/2018 10:59:24 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H5521	801	0	2019	National		1	6528400	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	802	0	1	04	01	H5521_802_0	4	1				06/04/2018	2019.01	06/04/2018 10:59:44 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (PPO)	01	04		1			H5521	802	0	2019	National		1	2435160	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	805	0	2	04	01	H5521_805_0	4	1				06/04/2018	2019.01	06/04/2018 11:00:01 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only Plan (PPO)	01	04		2	1		H5521	805	0	2019	National		1	141240	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	806	0	2	04	01	H5521_806_0	4	1				06/04/2018	2019.01	06/04/2018 11:00:18 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only Plan w/Rx CY (PPO)	01	04		2	1		H5521	806	0	2019	National		1	830	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	001	0	1	04	01	H5522_001_0	3	1			1	06/26/2018	2019.01	06/26/2018 09:14:39 AM Eastern Daylight Time	08/02/2018 06:53:25 PM Eastern Daylight Time	08/01/2018 12:02:46 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Gold (PPO)	01	04		1			H5522	001	0	2019	Allegheny County		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	002	0	1	04	01	H5522_002_0	4	1			2	05/29/2018	2019.01	05/29/2018 10:30:43 PM Eastern Daylight Time	08/02/2018 06:52:29 PM Eastern Daylight Time	08/01/2018 12:03:42 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Gold (PPO)	01	04		1			H5522	002	0	2019	Central Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	004	0	1	04	01	H5522_004_0	2	1			2	08/01/2018	2019.01	08/01/2018 07:16:04 PM Eastern Daylight Time	08/02/2018 06:51:18 PM Eastern Daylight Time	08/01/2018 12:04:38 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (PPO)	01	04		1			H5522	004	0	2019	Central Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	005	0	1	04	01	H5522_005_0	2	1			1	08/03/2018	2019.01	08/03/2018 09:26:33 AM Eastern Daylight Time	08/02/2018 06:50:09 PM Eastern Daylight Time	08/01/2018 12:05:36 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (PPO)	01	04		1			H5522	005	0	2019	Western Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	013	0	1	04	01	H5522_013_0	2	1			2	08/03/2018	2019.01	08/03/2018 09:25:30 AM Eastern Daylight Time	08/02/2018 06:48:58 PM Eastern Daylight Time	08/01/2018 12:06:30 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Silver Plus (PPO)	01	04		1			H5522	013	0	2019	Central Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	014	0	1	04	01	H5522_014_0	2	1			2	05/29/2018	2019.01	05/29/2018 10:30:20 PM Eastern Daylight Time	08/02/2018 06:48:06 PM Eastern Daylight Time	08/01/2018 12:07:26 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Gold (PPO)	01	04		1			H5522	014	0	2019	Southeastern PA		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	017	0	1	04	01	H5522_017_0	2	1			2	08/03/2018	2019.01	08/03/2018 09:28:30 AM Eastern Daylight Time	08/02/2018 06:46:59 PM Eastern Daylight Time	08/01/2018 12:08:18 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	AdvantraOne (PPO)	01	04		1			H5522	017	0	2019	Pennsylvania		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	018	0	1	04	01	H5522_018_0	2	1			2	05/24/2018	2019.01	05/24/2018 10:45:26 AM Eastern Daylight Time	08/02/2018 06:45:49 PM Eastern Daylight Time	08/01/2018 12:09:12 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	www.coventry-medicare.com	Advantra Silver (PPO)	01	04		1			H5522	018	0	2019	Allegheny		2		2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/formulary	www.coventry-medicare.com/findprovider	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(844)741-8423		(844)741-8423		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	802	0	1	04	01	H5522_802_0	4	1				06/04/2018	2019.01	06/04/2018 11:00:49 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra MA Only (PPO)	01	04		1			H5522	802	0	2019	Pennsylvania		1	120	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	803	0	1	04	01	H5522_803_0	4	1				06/04/2018	2019.01	06/04/2018 11:01:05 AM Eastern Daylight Time					06/04/2018 11:20:20 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	803	0	2019	Pennsylvania		1	102970	2			2						http://www.coventry-medicare.com/findpharmacy	https://www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(855)275-5888		(855)275-5888		(844)741-8423		(844)741-8423		(855)275-5888		(855)275-5888		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5525	004	0	1	04	01	H5525_004_0	5	1				07/05/2018	2019.01	07/05/2018 04:42:00 PM Eastern Daylight Time	07/18/2018 03:02:14 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-004 (PPO)	01	04		1			H5525	004	0	2019	Peoria Illinois area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	005	0	1	04	01	H5525_005_0	5	1				07/18/2018	2019.01	07/18/2018 04:17:43 PM Eastern Daylight Time	06/01/2018 01:35:53 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-005 (PPO)	01	04		1			H5525	005	0	2019	Greater Philadelphia Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	006	0	1	04	01	H5525_006_0	4	1				07/11/2018	2019.01	07/11/2018 12:19:58 PM Eastern Daylight Time	06/01/2018 01:31:40 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-006 (PPO)	01	04		1			H5525	006	0	2019	South Central Pennsylvania area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	007	0	1	04	01	H5525_007_0	5	1				07/18/2018	2019.01	07/18/2018 05:09:07 PM Eastern Daylight Time	06/01/2018 01:29:17 PM Eastern Daylight Time	08/03/2018 09:21:14 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-007 (PPO)	01	04		1			H5525	007	0	2019	North Central Pennsylvania area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	008	0	1	04	01	H5525_008_0	3	1				07/06/2018	2019.01	07/06/2018 11:19:48 AM Eastern Daylight Time	06/01/2018 01:13:58 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-008 (PPO)	01	04		1			H5525	008	0	2019	Select counties in Suburban Indiana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	015	0	1	04	01	H5525_015_0	3	1				07/02/2018	2019.01	07/02/2018 01:08:04 PM Eastern Daylight Time	06/01/2018 03:19:56 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-015 (PPO)	01	04		1			H5525	015	0	2019	Select Louisiana Parishes		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	017	0	1	04	01	H5525_017_0	5	1				07/18/2018	2019.01	07/18/2018 04:48:57 PM Eastern Daylight Time	08/03/2018 03:24:31 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-017 (PPO)	01	04		1			H5525	017	0	2019	Western Pennsylvania Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	020	0	1	04	01	H5525_020_0	3	1				07/03/2018	2019.01	07/03/2018 09:25:43 AM Eastern Daylight Time	06/01/2018 01:30:40 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-020 (PPO)	01	04		1			H5525	020	0	2019	Mobile Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	022	0	1	04	01	H5525_022_0	3	1				07/05/2018	2019.01	07/05/2018 01:39:19 PM Eastern Daylight Time	08/03/2018 03:28:05 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-022 (PPO)	01	04		1			H5525	022	0	2019	Select counties in Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	023	0	1	04	01	H5525_023_0	3	1				07/05/2018	2019.01	07/05/2018 01:39:38 PM Eastern Daylight Time	06/01/2018 01:40:29 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-023 (PPO)	01	04		1			H5525	023	0	2019	Select counties in West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	024	0	1	04	01	H5525_024_0	3	1				07/02/2018	2019.01	07/02/2018 01:23:54 PM Eastern Daylight Time	06/01/2018 03:01:38 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:13:44 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-024 (PPO)	01	04		1			H5525	024	0	2019	Select Counties in Georgia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	025	0	1	04	01	H5525_025_0	3	1				07/02/2018	2019.01	07/02/2018 12:51:38 PM Eastern Daylight Time	06/01/2018 03:16:41 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-025 (PPO)	01	04		1			H5525	025	0	2019	Select Counties in South Carolina		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	026	0	1	04	01	H5525_026_0	4	1				07/03/2018	2019.01	07/03/2018 11:11:39 AM Eastern Daylight Time	07/17/2018 10:16:16 AM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:43:50 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-026 (PPO)	01	04		1			H5525	026	0	2019	Select Counties in North Carolina		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	027	0	1	04	01	H5525_027_0	5	1				07/05/2018	2019.01	07/05/2018 04:50:24 PM Eastern Daylight Time	07/18/2018 03:04:40 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 11:05:14 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-027 (PPO)	01	04		1			H5525	027	0	2019	Select Counties in Montana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	030	0	1	04	01	H5525_030_0	4	1				07/11/2018	2019.01	07/11/2018 02:47:41 PM Eastern Daylight Time	06/01/2018 01:14:36 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-030 (PPO)	01	04		1			H5525	030	0	2019	Select Counties in Ohio and Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	031	0	1	04	01	H5525_031_0	4	1				07/05/2018	2019.01	07/05/2018 04:59:03 PM Eastern Daylight Time	07/18/2018 03:09:34 PM Eastern Daylight Time				07/18/2018 06:14:01 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-031 (PPO)	01	04		1			H5525	031	0	2019	Select Counties in Montana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5525	032	0	1	04	01	H5525_032_0	4	1				07/03/2018	2019.01	07/03/2018 11:12:40 AM Eastern Daylight Time	07/17/2018 10:25:27 AM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:43:50 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-032 (PPO)	01	04		1			H5525	032	0	2019	Triangle Perimeter		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	033	0	1	04	01	H5525_033_0	4	1				07/03/2018	2019.01	07/03/2018 11:13:30 AM Eastern Daylight Time	07/17/2018 10:25:56 AM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:43:50 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-033 (PPO)	01	04		1			H5525	033	0	2019	Wilmington Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	034	0	1	04	01	H5525_034_0	5	1				07/12/2018	2019.01	07/12/2018 10:22:25 AM Eastern Daylight Time	07/17/2018 10:26:25 AM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:43:50 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-034 (PPO)	01	04		1			H5525	034	0	2019	Wilmington Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	035	0	1	04	01	H5525_035_0	4	1				07/03/2018	2019.01	07/03/2018 11:15:21 AM Eastern Daylight Time	07/17/2018 10:30:26 AM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:43:50 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-035 (PPO)	01	04		1			H5525	035	0	2019	Select Counties in North Carolina		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	036	0	1	04	01	H5525_036_0	5	1	2	1		07/16/2018	2019.01	07/16/2018 01:07:27 PM Eastern Daylight Time	08/03/2018 09:56:46 AM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:43:50 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-036 (PPO SNP)	01	04		1			H5525	036	0	2019	Greater North Carolina Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	037	0	1	04	01	H5525_037_0	3	1				07/02/2018	2019.01	07/02/2018 03:49:25 PM Eastern Daylight Time	06/01/2018 03:30:32 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5525-037 (PPO)	01	04		1			H5525	037	0	2019	Select Louisiana Parishes		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	038	0	1	04	01	H5525_038_0	3	1				07/05/2018	2019.01	07/05/2018 01:39:54 PM Eastern Daylight Time	06/01/2018 01:51:55 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-038 (PPO)	01	04		1			H5525	038	0	2019	Pennsylvania		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	039	0	1	04	01	H5525_039_0	3	1				07/05/2018	2019.01	07/05/2018 01:40:07 PM Eastern Daylight Time	06/01/2018 01:52:22 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5525-039 (PPO)	01	04		1			H5525	039	0	2019	Pennsylvania		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	040	0	1	04	01	H5525_040_0	3	1				07/05/2018	2019.01	07/05/2018 01:40:22 PM Eastern Daylight Time	06/01/2018 01:49:40 PM Eastern Daylight Time	08/03/2018 09:21:15 AM Eastern Daylight Time			08/06/2018 11:09:30 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5525-040 (PPO)	01	04		1			H5525	040	0	2019	Select Counties in Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	041	0	1	04	01	H5525_041_0	3	1				07/05/2018	2019.01	07/05/2018 02:03:36 PM Eastern Daylight Time	06/01/2018 01:34:23 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5525-041 (PPO)	01	04		1			H5525	041	0	2019	Select counties in Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	042	0	1	04	01	H5525_042_0	4	1				07/11/2018	2019.01	07/11/2018 02:50:26 PM Eastern Daylight Time	06/01/2018 01:30:45 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:22:31 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-042 (PPO)	01	04		1			H5525	042	0	2019	Select counties in Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	809	0	1	04	01	H5525_809_0	1	1				05/31/2018	2019.01	05/31/2018 11:45:09 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	809	0	2019	Select Counties in Multi-States		1	228072	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	810	0	1	04	01	H5525_810_0	1	1				05/31/2018	2019.01	05/31/2018 11:46:25 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	810	0	2019	Select Counties in Multi-States		1	20624	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	811	0	1	04	01	H5525_811_0	1	1				05/31/2018	2019.01	05/31/2018 11:47:12 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5525	811	0	2019	Select Counties in Multi-States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	812	0	2	04	01	H5525_812_0	1	1				05/31/2018	2019.01	05/31/2018 11:47:35 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5525	812	0	2019	Select Counties in Multi-States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	813	0	2	04	01	H5525_813_0	1	1				05/31/2018	2019.01	05/31/2018 11:49:36 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5525	813	0	2019	Select Counties in Multi-States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	814	0	2	04	01	H5525_814_0	1	1				05/31/2018	2019.01	05/31/2018 11:50:27 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5525	814	0	2019	Select Counties in Multi-States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5526	004	0	1	04	01	H5526_004_0	6	1				08/07/2018	2019.01	08/07/2018 11:11:42 AM Eastern Daylight Time	08/07/2018 02:20:34 PM Eastern Daylight Time	08/07/2018 02:20:41 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Forever Blue 751 (PPO)	01	04		1			H5526	004	0	2019	Western New York		2		2			2						www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	016	0	1	04	01	H5526_016_0	6	1				08/03/2018	2019.01	08/03/2018 09:28:41 AM Eastern Daylight Time	08/07/2018 02:20:34 PM Eastern Daylight Time	08/07/2018 02:20:41 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Forever Blue Value (PPO)	01	04		1			H5526	016	0	2019	Western New York		2		2			2						www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	018	0	1	04	01	H5526_018_0	7	1				08/07/2018	2019.01	08/07/2018 11:13:53 AM Eastern Daylight Time	08/07/2018 02:20:34 PM Eastern Daylight Time	08/07/2018 02:20:41 PM Eastern Daylight Time			08/07/2018 02:29:30 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Forever Blue 770 (PPO)	01	04		1			H5526	018	0	2019	Northeastern New York		2		2			2						www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	806	0	1	04	01	H5526_806_0	2	1				06/01/2018	2019.01	06/01/2018 01:13:58 PM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	PPO Group (MA Only) CY (PPO)	01	04		1			H5526	806	0	2019	Western and Northeastern New York		1	11682	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;	2		1									
H5526	808	0	1	04	01	H5526_808_0	2	1				06/01/2018	2019.01	06/01/2018 01:14:13 PM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	PPO Group (MA-PD) CY (PPO)	01	04		1			H5526	808	0	2019	Western and Northeastern New York		1	125861	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1									
H5528	807	0	1	04	01	H5528_807_0	1	1				05/14/2018	2019.01	05/14/2018 04:27:48 PM Eastern Daylight Time					05/25/2018 03:07:24 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access Rx (PPO)	01	04		1			H5528	807	0	2019	United States		1	213	2			2						www.emblemhealth.com	www.emblemhealth.com		(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5533	003	0	1	04	01	H5533_003_0	7	1			1	07/12/2018	2019.01	07/12/2018 06:06:00 PM Eastern Daylight Time	08/02/2018 12:42:42 PM Eastern Daylight Time	08/01/2018 11:25:09 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO High Deductible with Rx (PPO)	01	04		1			H5533	003	0	2019	Western Pennsylvania		2	67826	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2						2			
H5533	005	0	1	04	01	H5533_005_0	7	1			1	07/12/2018	2019.01	07/12/2018 06:07:51 PM Eastern Daylight Time	08/02/2018 12:43:49 PM Eastern Daylight Time	08/01/2018 11:26:51 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	005	0	2019	Western PA		2	34452	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2						2			
H5533	007	0	1	04	01	H5533_007_0	5	1			2	07/12/2018	2019.01	07/12/2018 06:09:39 PM Eastern Daylight Time	08/01/2018 02:14:30 PM Eastern Daylight Time	08/01/2018 11:28:32 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	007	0	2019	Berks County		2	790	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2						2			
H5533	008	0	1	04	01	H5533_008_0	5	1			2	07/12/2018	2019.01	07/12/2018 06:11:07 PM Eastern Daylight Time	08/01/2018 02:15:40 PM Eastern Daylight Time	08/01/2018 11:38:34 AM Eastern Daylight Time			08/02/2018 02:59:05 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	008	0	2019	South Central PA		2	11499	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2						2			
H5533	801	0	1	04	01	H5533_801_0	1	1				06/01/2018	2019.01	06/01/2018 08:59:30 PM Eastern Daylight Time					06/02/2018 09:34:03 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PPO)	01	04		1			H5533	801	0	2019	Western Pennsylvania		1	51	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										1	1	1a;1b;2;6;7b;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H5533	802	0	1	04	01	H5533_802_0	1	1				06/01/2018	2019.01	06/01/2018 09:00:01 PM Eastern Daylight Time					06/02/2018 09:34:03 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	802	0	2019	Western Pennsylvania		1	10365	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;6;7b;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H5533	803	0	1	04	01	H5533_803_0	1	1				06/01/2018	2019.01	06/01/2018 09:00:15 PM Eastern Daylight Time					06/02/2018 09:34:03 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	803	0	2019	Western Pennsylvania		1	12	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;6;7b;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H5549	003	0	1	01	01	H5549_003_0	10	1	2	1		08/07/2018	2019.01	08/07/2018 11:17:49 AM Eastern Daylight Time	08/07/2018 11:01:09 AM Eastern Daylight Time	08/07/2018 11:01:10 AM Eastern Daylight Time			08/07/2018 11:19:03 AM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Total (HMO SNP)	01	01		1			H5549	003	0	2019	New York Metro Area		2		2			1	3		1		1	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	www.vnsnychoice.org	(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	008	0	1	02	01	H5576_008_0	8	1				08/03/2018	2019.01	08/03/2018 02:16:20 PM Central Daylight Time	08/01/2018 11:48:50 AM Central Daylight Time	08/01/2018 09:12:06 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA4 Vantage TRADITIONAL PLUS (HMO-POS)	01	02		1			H5576	008	0	2019	State of Louisiana		2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	017	1	1	02	01	H5576_017_1	11	1				07/30/2018	2019.01	07/30/2018 12:02:45 PM Central Daylight Time	08/01/2018 12:03:46 PM Central Daylight Time	08/01/2018 09:13:22 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA0 Vantage STANDARD (HMO-POS)	01	02		1			H5576	017	1	2019	North, Central, and South LA	NE LA, EBR, SHEL, and TANG parishes	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	1	01	7a;7g;8a1;8a2;8b1;8b3;9a1;14e2;	
H5576	017	2	1	02	01	H5576_017_2	10	1				07/30/2018	2019.01	07/30/2018 12:02:59 PM Central Daylight Time	08/01/2018 12:05:14 PM Central Daylight Time	08/01/2018 09:14:18 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA0 Vantage STANDARD (HMO-POS)	01	02		1			H5576	017	2	2019	North, Central, and South LA	North, Central, and South LA	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	018	1	1	02	01	H5576_018_1	10	1				07/30/2018	2019.01	07/30/2018 12:03:12 PM Central Daylight Time	08/01/2018 12:13:18 PM Central Daylight Time	08/01/2018 09:15:56 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA1 Vantage PREMIUM (HMO-POS)	01	02		1			H5576	018	1	2019	North, Central, and South LA	NE LA, EBR, SHEL, and TANG parishes	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	1	01	7a;7g;8a1;8a2;8b1;8b3;9a1;14e2;	
H5576	018	2	1	02	01	H5576_018_2	10	1				07/30/2018	2019.01	07/30/2018 12:03:26 PM Central Daylight Time	08/01/2018 12:14:26 PM Central Daylight Time	08/01/2018 09:17:06 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA1 Vantage PREMIUM (HMO-POS)	01	02		1			H5576	018	2	2019	North, Central, and South LA	North, Central, and South LA	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	019	0	1	02	01	H5576_019_0	8	1	2	1		08/03/2018	2019.01	08/03/2018 02:16:47 PM Central Daylight Time	08/01/2018 12:15:54 PM Central Daylight Time	08/01/2018 09:18:00 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA7 Vantage Dual Special Needs Plan (HMO-POS SNP)	01	02		1			H5576	019	0	2019	State of Louisiana		2		2			1	3		2		2	www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	020	1	1	02	01	H5576_020_1	10	1				07/30/2018	2019.01	07/30/2018 12:03:38 PM Central Daylight Time	08/01/2018 12:17:04 PM Central Daylight Time	08/01/2018 09:19:24 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA8 Vantage BASIC (HMO-POS)	01	02		1			H5576	020	1	2019	North, Central, and South LA	NE LA, EBR, SHEL, and TANG parishes	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	1	01	7a;7g;8a1;8a2;8b1;8b3;9a1;14e2;	
H5576	020	2	1	02	01	H5576_020_2	10	1				07/30/2018	2019.01	07/30/2018 12:03:50 PM Central Daylight Time	08/01/2018 12:18:14 PM Central Daylight Time	08/01/2018 09:20:22 AM Central Daylight Time			08/03/2018 03:13:53 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA8 Vantage BASIC (HMO-POS)	01	02		1			H5576	020	2	2019	North, Central, and South LA	North, Central, and South LA	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	022	0	1	02	01	H5576_022_0	7	1				06/01/2018	2019.01	06/01/2018 03:32:28 PM Central Daylight Time	08/01/2018 11:45:48 AM Central Daylight Time	08/01/2018 09:11:00 AM Central Daylight Time			08/06/2018 07:57:32 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA9 Vantage 100 (HMO-POS)	01	02		1			H5576	022	0	2019	East and West Carroll parishes		2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	801	0	1	02	01	H5576_801_0	3	1				05/30/2018	2019.01	05/30/2018 05:03:26 PM Central Daylight Time					05/31/2018 11:16:43 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MAPD Employer Calendar (HMO-POS)	01	02		1			H5576	801	0	2019	Louisiana		1	25788	2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	802	0	1	02	01	H5576_802_0	3	1				05/30/2018	2019.01	05/30/2018 05:03:33 PM Central Daylight Time					05/31/2018 11:16:43 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MAPD Emp Non-Calendar (HMO-POS)	01	02		1			H5576	802	0	2019	Louisiana		1	0	2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	803	0	1	02	01	H5576_803_0	3	1				05/30/2018	2019.01	05/30/2018 05:03:41 PM Central Daylight Time					05/31/2018 11:16:43 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MA Employer Calendar (HMO-POS)	01	02		1			H5576	803	0	2019	Louisiana		1	0	2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1									(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131										2					2					2	2			
H5577	002	0	1	01	01	H5577_002_0	4	1	1	1		06/03/2018	2019.01	06/03/2018 04:55:35 PM SA Western Standard Time	08/01/2018 02:23:46 PM SA Western Standard Time	08/01/2018 02:10:44 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Ideal (HMO SNP)	01	01		1			H5577	002	0	2019	Puerto Rico		2	79535	2		1	1	3		2		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	005	0	1	01	01	H5577_005_0	4	1				06/03/2018	2019.01	06/03/2018 04:56:37 PM SA Western Standard Time	08/01/2018 02:24:56 PM SA Western Standard Time	08/01/2018 02:11:30 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare InteliCare (HMO)	01	01		1			H5577	005	0	2019	Puerto Rico		2	137804	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	1	01	7d;7f;8a2;	
H5577	008	0	1	02	01	H5577_008_0	4	1				06/03/2018	2019.01	06/03/2018 04:57:16 PM SA Western Standard Time	08/01/2018 02:26:10 PM SA Western Standard Time	08/01/2018 02:12:06 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Essential (HMO-POS)	01	02		1			H5577	008	0	2019	Puerto Rico		2	559278	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	1	01	7d;7f;8a2;	
H5577	014	0	1	01	01	H5577_014_0	4	1				06/03/2018	2019.01	06/03/2018 04:58:04 PM SA Western Standard Time	08/01/2018 02:27:22 PM SA Western Standard Time	08/01/2018 02:12:44 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediCa$h (HMO)	01	01		1			H5577	014	0	2019	Puerto Rico		2	12649	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	016	0	1	01	01	H5577_016_0	3	1				06/03/2018	2019.01	06/03/2018 04:58:38 PM SA Western Standard Time	07/18/2018 03:50:50 PM SA Western Standard Time				07/21/2018 11:20:40 AM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediOnlyNoRx (HMO)	01	01		1			H5577	016	0	2019	Puerto Rico		2	6547	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528										(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182										2					2					2	1	01	7d;7f;8a2;	
H5577	017	0	1	01	01	H5577_017_0	4	1	1	1		06/03/2018	2019.01	06/03/2018 04:59:33 PM SA Western Standard Time	08/01/2018 02:28:32 PM SA Western Standard Time	08/01/2018 02:13:24 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Progreso (HMO SNP)	01	01		1			H5577	017	0	2019	Puerto Rico		2	533094	2		1	1	3		2		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	027	0	1	01	01	H5577_027_0	4	1	1	1		06/03/2018	2019.01	06/03/2018 04:59:57 PM SA Western Standard Time	08/01/2018 02:29:44 PM SA Western Standard Time	08/01/2018 02:14:10 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Cmodo (HMO SNP)	01	01		1			H5577	027	0	2019	Puerto Rico		2	190550	2		1	1	3		2		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	028	0	1	01	01	H5577_028_0	5	1	1	1		06/21/2018	2019.01	06/21/2018 02:52:19 PM SA Western Standard Time	08/01/2018 02:30:58 PM SA Western Standard Time	08/01/2018 02:15:00 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Clsico (HMO SNP)	01	01		1			H5577	028	0	2019	Puerto Rico		2	279470	2		1	1	3		2		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	029	0	1	01	01	H5577_029_0	4	1	1	1		06/03/2018	2019.01	06/03/2018 05:01:50 PM SA Western Standard Time	08/01/2018 02:32:12 PM SA Western Standard Time	08/01/2018 02:15:52 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino MsCa$h (HMO SNP)	01	01		1			H5577	029	0	2019	Puerto Rico		2	114481	2		1	1	3		2		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	030	0	1	01	01	H5577_030_0	4	1				06/03/2018	2019.01	06/03/2018 05:02:16 PM SA Western Standard Time	08/01/2018 02:33:32 PM SA Western Standard Time	08/01/2018 02:16:40 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare ExceD (HMO)	01	01		1			H5577	030	0	2019	Puerto Rico		2	6482	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	1	01	7d;7f;8a2;	
H5577	031	0	1	01	01	H5577_031_0	4	1				06/03/2018	2019.01	06/03/2018 05:02:46 PM SA Western Standard Time	08/01/2018 02:34:42 PM SA Western Standard Time	08/01/2018 02:17:22 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Activo (HMO)	01	01		1			H5577	031	0	2019	Puerto Rico		2	150178	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	1	01	7d;7f;8a2;	
H5577	036	0	1	01	01	H5577_036_0	4	1	1	1		06/03/2018	2019.01	06/03/2018 05:03:22 PM SA Western Standard Time	08/01/2018 02:35:52 PM SA Western Standard Time	08/01/2018 02:18:08 PM SA Western Standard Time			08/07/2018 02:24:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino OTC (HMO SNP)	01	01		1			H5577	036	0	2019	Puerto Rico		2	19427	2		1	1	3		2		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	801	0	1	01	01	H5577_801_0	2	1				06/01/2018	2019.01	06/01/2018 06:05:31 PM SA Western Standard Time					06/03/2018 05:13:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA Group (HMO)	01	01		1			H5577	801	0	2019	Puerto Rico		1	1200	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528										(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182										1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	2		2					1				
H5577	802	0	1	01	01	H5577_802_0	2	1				06/01/2018	2019.01	06/01/2018 06:05:46 PM SA Western Standard Time					06/03/2018 05:13:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group (HMO)	01	01		1			H5577	802	0	2019	Puerto Rico		1	67248	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	2		2					1				
H5577	809	0	1	01	01	H5577_809_0	2	1				06/01/2018	2019.01	06/01/2018 06:06:02 PM SA Western Standard Time					06/03/2018 05:13:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2nd Formulary Opt. (HMO)	01	01		1			H5577	809	0	2019	Puerto Rico		1	256738	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	2		2					1				
H5577	813	0	1	01	01	H5577_813_0	2	1				06/01/2018	2019.01	06/01/2018 06:06:19 PM SA Western Standard Time					06/03/2018 05:13:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA Group NC (HMO)	01	01		1			H5577	813	0	2019	Puerto Rico		1	1200	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528										(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182										1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	2		2					1				
H5577	814	0	1	01	01	H5577_814_0	2	1				06/01/2018	2019.01	06/01/2018 06:06:35 PM SA Western Standard Time					06/03/2018 05:13:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group NC (HMO)	01	01		1			H5577	814	0	2019	Puerto Rico		1	600	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	2		2					1				
H5577	815	0	1	01	01	H5577_815_0	2	1				06/01/2018	2019.01	06/01/2018 06:06:48 PM SA Western Standard Time					06/03/2018 05:13:28 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2nd Formulary Opt. NC (HMO)	01	01		1			H5577	815	0	2019	Puerto Rico		1	600	2			2						www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	2		2					1				
H5580	001	0	1	01	01	H5580_001_0	6	1	2	1		08/06/2018	2019.01	08/06/2018 10:24:43 AM Pacific Daylight Time	08/06/2018 09:32:06 AM Pacific Daylight Time	08/06/2018 01:30:53 PM Pacific Daylight Time			08/06/2018 04:24:26 PM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	001	0	2019	Maricopa, Pinal, and Gila Counties		2	135627	2			1	3		1		1	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5580	004	0	1	01	01	H5580_004_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 10:25:19 AM Pacific Daylight Time	08/06/2018 09:32:42 AM Pacific Daylight Time	08/06/2018 01:31:38 PM Pacific Daylight Time			08/06/2018 04:24:26 PM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	004	0	2019	Maricopa, Gila, Pinal, and Pima Counties		2	59081	2			1	3		1		1	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5580	005	0	1	01	01	H5580_005_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 10:25:50 AM Pacific Daylight Time	08/06/2018 09:30:51 AM Pacific Daylight Time	08/06/2018 01:32:29 PM Pacific Daylight Time			08/06/2018 04:24:26 PM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	005	0	2019	Maricopa, Pima and Santa Cruz Counties		2	15786	2			1	3		1		1	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5587	002	0	1	01	01	H5587_002_0	12	1	2	1		07/19/2018	2019.01	07/19/2018 04:37:27 PM Pacific Daylight Time	08/07/2018 10:16:26 AM Pacific Daylight Time	08/07/2018 10:16:28 AM Pacific Daylight Time			08/07/2018 10:22:55 AM Pacific Daylight Time	HEALTH CHOICE ARIZONA, INC.	Steward Health Choice Generations (HMO SNP)	www.healthchoicegenerations.com	Steward Health Choice Generations (HMO SNP)	01	01		1			H5587	002	0	2019	Counties: APA, CCN, GIL, MAR, MOH, NAV, PIN, YAV		2		2			1	3		2		1	http://www.hcgenerations.com	http://www.hcgenerations.com/index.asp?page=formulary.asp&f=partd	http://www.healthchoicearizona.com/Directory/search.asp?bl=hcg	(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	004	0	1	01	01	H5590_004_0	6	1				07/25/2018	2019.01	07/25/2018 10:06:34 AM Pacific Daylight Time	08/03/2018 11:06:32 AM Pacific Daylight Time	08/03/2018 05:57:28 PM Pacific Daylight Time			08/03/2018 10:48:33 PM Pacific Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.healthnetadvantage.com	Allwell Medicare (HMO)	01	01		1			H5590	004	0	2019	Yuma County		2		2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(877)935-8020		(877)935-8020		(877)826-5526		(877)826-5526		(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	005	0	1	01	01	H5590_005_0	10	1				08/01/2018	2019.01	08/01/2018 05:34:40 PM Pacific Daylight Time	08/05/2018 01:28:20 PM Pacific Daylight Time	08/01/2018 10:58:26 AM Pacific Daylight Time			08/07/2018 01:58:15 PM Pacific Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.healthnetadvantage.com	Allwell Medicare Essentials (HMO)	01	01		1			H5590	005	0	2019	Maricopa and Pinal counties		2		2			2						allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(877)935-8020		(877)935-8020		(877)826-5526		(877)826-5526		(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	006	1	1	01	01	H5590_006_1	7	1	2	1		07/25/2018	2019.01	07/25/2018 10:06:51 AM Pacific Daylight Time	08/03/2018 11:08:16 AM Pacific Daylight Time	08/03/2018 06:10:58 PM Pacific Daylight Time			08/03/2018 10:48:33 PM Pacific Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.healthnetadvantage.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5590	006	1	2019	Central and Southern AZ Counties	Maricopa, Pima, Yuma	2		2			1	3		2		2	allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(877)935-8020		(877)935-8020		(877)826-5526		(877)826-5526		(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	006	2	1	01	01	H5590_006_2	7	1	2	1		07/25/2018	2019.01	08/03/2018 10:43:06 PM Pacific Daylight Time	08/03/2018 11:09:14 AM Pacific Daylight Time	08/03/2018 06:14:56 PM Pacific Daylight Time			08/03/2018 10:48:33 PM Pacific Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.healthnetadvantage.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H5590	006	2	2019	Central and Southern AZ Counties	Southern AZ Counties	2		2			1	3		2		2	allwell.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(877)935-8020		(877)935-8020		(877)826-5526		(877)826-5526		(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	001	0	1	02	01	H5591_001_0	7	1				07/16/2018	2019.01	07/16/2018 05:30:41 PM Eastern Daylight Time	08/07/2018 12:44:22 PM Eastern Daylight Time	08/07/2018 12:44:31 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	001	0	2019	Northern Maine & Northern New Hampshire		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	003	0	1	01	01	H5591_003_0	9	1				08/08/2018	2019.01	08/08/2018 02:24:58 PM Eastern Daylight Time	07/27/2018 07:50:10 AM Eastern Daylight Time				08/08/2018 02:25:28 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value (HMO)	01	01		1			H5591	003	0	2019	Maine & NH Counties: CA,CH,CO,GR,HI,RO,ST,SU		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5591	005	0	1	02	01	H5591_005_0	7	1				07/23/2018	2019.01	07/23/2018 05:55:53 PM Eastern Daylight Time	08/07/2018 12:44:21 PM Eastern Daylight Time	08/07/2018 12:44:30 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	005	0	2019	Southern NH Counties: Ches,Hill,Rock,Straf,Sull		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	1	1	02	01	H5591_006_1	7	1				07/16/2018	2019.01	07/16/2018 05:30:50 PM Eastern Daylight Time	08/07/2018 12:44:20 PM Eastern Daylight Time	08/07/2018 12:44:30 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	1	2019	Southern Maine: Andr, Cumb, Kenn, Saga, York	Southern Maine: Cumberland	2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	2	1	02	01	H5591_006_2	7	1				07/16/2018	2019.01	07/16/2018 05:23:44 PM Eastern Daylight Time	08/07/2018 12:44:19 PM Eastern Daylight Time	08/07/2018 12:44:29 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	2	2019	Southern Maine: Andr, Cumb, Kenn, Saga, York	Southern Maine: Kennebec, Sagadahoc, York	2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	007	0	1	01	01	H5591_007_0	6	1		1		07/16/2018	2019.01	07/16/2018 10:57:50 AM Eastern Daylight Time	08/07/2018 12:44:18 PM Eastern Daylight Time	08/07/2018 12:44:28 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Focus DC (HMO SNP)	01	01		1			H5591	007	0	2019	Cumberland County		2		2			1	4			00000010000000000000		www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	009	0	1	01	01	H5591_009_0	6	1				07/12/2018	2019.01	07/12/2018 06:27:42 PM Eastern Daylight Time	08/07/2018 12:44:17 PM Eastern Daylight Time	08/07/2018 12:44:26 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value Plus (HMO)	01	01		1			H5591	009	0	2019	ME Counties: AR,FR,HA,KN,LI,OX,PE,PI,SO,Waldo,Wash		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	013	0	1	01	01	H5591_013_0	6	1				07/12/2018	2019.01	07/12/2018 06:27:30 PM Eastern Daylight Time	08/07/2018 12:44:16 PM Eastern Daylight Time	08/07/2018 12:44:25 PM Eastern Daylight Time			08/07/2018 06:26:29 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value Plus (HMO)	01	01		1			H5591	013	0	2019	ME Counties: And,Ken,Sag,Yo & NH Counties:Hil,Stra		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	801	0	1	02	01	H5591_801_0	4	1				04/16/2018	2019.01	04/16/2018 05:17:47 PM Eastern Daylight Time					06/04/2018 09:04:06 AM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	801	0	2019	National		1	0	2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	802	0	1	02	01	H5591_802_0	4	1				04/16/2018	2019.01	04/16/2018 05:17:45 PM Eastern Daylight Time					06/04/2018 09:04:06 AM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	802	0	2019	National		1	0	2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	001	0	1	01	01	H5594_001_0	7	1				06/22/2018	2019.01	06/22/2018 10:52:45 AM Eastern Daylight Time	08/03/2018 09:14:10 AM Eastern Daylight Time	08/02/2018 03:35:28 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	001	0	2019	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	002	0	1	01	01	H5594_002_0	7	1				06/22/2018	2019.01	06/22/2018 10:52:58 AM Eastern Daylight Time	08/03/2018 09:15:14 AM Eastern Daylight Time	08/02/2018 03:36:24 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	01	01		1			H5594	002	0	2019	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	016	0	1	01	01	H5594_016_0	7	1	2	1		06/22/2018	2019.01	06/22/2018 10:53:11 AM Eastern Daylight Time	08/03/2018 09:16:16 AM Eastern Daylight Time	08/02/2018 03:37:14 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Partial (HMO SNP)	01	01		1			H5594	016	0	2019	Select Counties in Florida		2	0	2			1	3		2		2	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	017	0	1	01	01	H5594_017_0	7	1	2	1		06/22/2018	2019.01	06/22/2018 10:53:25 AM Eastern Daylight Time	08/03/2018 09:17:20 AM Eastern Daylight Time	08/02/2018 03:37:54 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Full (HMO SNP)	01	01		1			H5594	017	0	2019	Select Counties in Florida		2	0	2			1	3		1		1	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	019	0	1	01	01	H5594_019_0	7	1				06/22/2018	2019.01	06/22/2018 10:53:38 AM Eastern Daylight Time	08/03/2018 09:18:48 AM Eastern Daylight Time	08/02/2018 03:38:34 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	01	01		1			H5594	019	0	2019	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	022	0	1	01	01	H5594_022_0	7	1				06/22/2018	2019.01	06/22/2018 10:53:51 AM Eastern Daylight Time	08/03/2018 09:19:50 AM Eastern Daylight Time	08/02/2018 03:39:14 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	022	0	2019	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	026	0	1	01	01	H5594_026_0	7	1				06/22/2018	2019.01	06/22/2018 10:54:05 AM Eastern Daylight Time	08/03/2018 09:20:52 AM Eastern Daylight Time	08/02/2018 03:39:54 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	026	0	2019	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	028	0	1	01	01	H5594_028_0	7	1		1		06/22/2018	2019.01	06/22/2018 10:54:18 AM Eastern Daylight Time	08/03/2018 09:21:56 AM Eastern Daylight Time	08/02/2018 03:40:36 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO SNP)	01	01		1			H5594	028	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	029	0	1	01	01	H5594_029_0	7	1		1		06/22/2018	2019.01	06/22/2018 10:54:34 AM Eastern Daylight Time	08/03/2018 09:23:18 AM Eastern Daylight Time	08/02/2018 03:42:44 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO SNP)	01	01		1			H5594	029	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	030	0	1	01	01	H5594_030_0	7	1		1		06/22/2018	2019.01	06/22/2018 10:54:48 AM Eastern Daylight Time	08/03/2018 09:24:26 AM Eastern Daylight Time	08/02/2018 03:43:24 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO SNP)	01	01		1			H5594	030	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	031	0	1	01	01	H5594_031_0	7	1		1		06/22/2018	2019.01	06/22/2018 10:55:01 AM Eastern Daylight Time	08/03/2018 09:25:38 AM Eastern Daylight Time	08/02/2018 03:44:10 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO SNP)	01	01		1			H5594	031	0	2019	Select Counties in Florida		2	0	2			1	4			00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	032	0	1	01	01	H5594_032_0	7	1				06/22/2018	2019.01	06/22/2018 10:55:14 AM Eastern Daylight Time	08/03/2018 09:26:40 AM Eastern Daylight Time	08/02/2018 03:45:38 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Plus Plan (HMO)	01	01		1			H5594	032	0	2019	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	034	0	1	01	01	H5594_034_0	8	1		1		06/22/2018	2019.01	06/22/2018 10:55:27 AM Eastern Daylight Time	08/03/2018 09:27:50 AM Eastern Daylight Time	08/02/2018 03:46:12 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO SNP)	01	01		1			H5594	034	0	2019	select counties in FL		2	0	2			1	4			00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	035	0	1	01	01	H5594_035_0	8	1		1		06/22/2018	2019.01	06/22/2018 10:55:39 AM Eastern Daylight Time	08/03/2018 09:31:42 AM Eastern Daylight Time	08/02/2018 03:46:46 PM Eastern Daylight Time			08/03/2018 04:52:51 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO SNP)	01	01		1			H5594	035	0	2019	select counties in FL		2	0	2			1	4			00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5608	001	0	1	01	01	H5608_001_0	4	1	2	1		08/07/2018	2019.01	08/07/2018 10:27:18 AM Mountain Daylight Time	08/07/2018 10:25:50 AM Mountain Daylight Time	08/07/2018 10:25:50 AM Mountain Daylight Time			08/07/2018 10:28:20 AM Mountain Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	http://www.denverhealthmedicalplan.org	Denver Health Medicare Choice (HMO SNP)	01	01		1			H5608	001	0	2019	Denver County		2	20004	2			1	3		1		1	http://www.denverhealthmedicalplan.org	http://www.denverhealthmedicalplan.org	http://www.denverhealthmedicalplan.org	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5608	002	0	1	01	01	H5608_002_0	4	1				08/06/2018	2019.01	08/06/2018 12:55:44 PM Mountain Daylight Time	08/07/2018 10:25:50 AM Mountain Daylight Time	08/07/2018 10:25:50 AM Mountain Daylight Time			08/07/2018 10:28:20 AM Mountain Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	http://www.denverhealthmedicalplan.org	Denver Health Medicare Select (HMO)	01	01		1			H5608	002	0	2019	Denver County		2	35118	2			2						http://www.denverhealthmedicalplan.org	http://www.denverhealthmedicalplan.org	http://www.denverhealthmedicalplan.org	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5610	001	0	1	20	08	H5610_001_0	1	1				05/31/2018	2019.01	05/31/2018 09:48:30 AM Eastern Daylight Time		05/30/2018 04:25:20 PM Eastern Daylight Time			05/31/2018 09:50:59 AM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	08	20		1			H5610	001	0	2019	Kent County		2		2			2						www.care-resources.org	www.care-resources.org										(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(616)913-2006		(800)649-3777		(616)913-2006																
H5610	003	0	1	20	08	H5610_003_0	1	1				05/31/2018	2019.01	05/31/2018 09:49:06 AM Eastern Daylight Time		05/30/2018 04:25:10 PM Eastern Daylight Time			05/31/2018 09:50:59 AM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	08	20		1			H5610	003	0	2019	Kent County		2		2			2						www.care-resources.org	www.care-resources.org										(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(616)913-2006		(800)649-3777		(616)913-2006																
H5613	002	0		07	02	H5613_002_0	3	2				05/31/2018	2019.01	05/31/2018 12:39:45 PM Eastern Daylight Time			06/03/2018 09:56:35 AM Eastern Daylight Time		06/03/2018 01:26:00 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	mvphealthcare.com	SmartFund (MSA)	02	07	2				H5613	002	0	2019	Eastern NY		2	2224	2			2									(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5613	801	0		07	02	H5613_801_0	1	2				04/25/2018	2019.01	04/25/2018 02:48:47 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	mvphealthcare.com	SmartFund EG (MSA)	02	07	2				H5613	801	0	2019	Western NY		1	300	2			2									(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5613	802	0		07	02	H5613_802_0	1	2				04/25/2018	2019.01	04/25/2018 02:48:58 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	mvphealthcare.com	SmartFund EG (MSA)	02	07	2				H5613	802	0	2019	Eastern NY		1	444	2			2									(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5619	001	0	1	01	01	H5619_001_0	4	1				07/02/2018	2019.01	07/02/2018 12:04:09 PM Eastern Daylight Time	06/01/2018 03:11:45 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:58:51 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-001 (HMO)	01	01		1			H5619	001	0	2019	Southern Maine Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	003	0	1	01	01	H5619_003_0	4	1	2	1		07/02/2018	2019.01	07/02/2018 03:56:37 PM Eastern Daylight Time	06/01/2018 03:10:20 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:58:51 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-003 (HMO SNP)	01	01		1			H5619	003	0	2019	Select Counties in Maine		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	012	0	1	01	01	H5619_012_0	4	1				07/02/2018	2019.01	07/02/2018 12:53:59 PM Eastern Daylight Time	07/18/2018 01:57:24 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-012 (HMO)	01	01		1			H5619	012	0	2019	Fresno County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	013	0	1	01	01	H5619_013_0	4	1				07/02/2018	2019.01	07/02/2018 12:55:18 PM Eastern Daylight Time	07/18/2018 02:03:16 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-013 (HMO)	01	01		1			H5619	013	0	2019	Madera County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	015	0	1	01	01	H5619_015_0	4	1				08/02/2018	2019.01	08/02/2018 11:23:00 AM Eastern Daylight Time	07/18/2018 01:58:01 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-015 (HMO)	01	01		1			H5619	015	0	2019	Tulare and Kings counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	3-1;3-2;4b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8a1;8b1;8b2;8b3;9c;16b;17a;18a;	
H5619	016	0	1	01	01	H5619_016_0	5	1				07/18/2018	2019.01	07/18/2018 05:23:21 PM Eastern Daylight Time	07/18/2018 01:59:23 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-016 (HMO)	01	01		1			H5619	016	0	2019	San Diego County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	021	0	1	01	01	H5619_021_0	5	1				07/18/2018	2019.01	07/18/2018 05:23:37 PM Eastern Daylight Time	07/18/2018 02:01:13 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-021 (HMO)	01	01		1			H5619	021	0	2019	Los Angeles and Orange counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	023	0	1	01	01	H5619_023_0	4	1				07/02/2018	2019.01	07/02/2018 01:02:16 PM Eastern Daylight Time	07/18/2018 02:01:56 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-023 (HMO)	01	01		1			H5619	023	0	2019	Santa Barbara (partial) and Ventura counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	026	0	1	01	01	H5619_026_0	5	1				07/02/2018	2019.01	07/02/2018 12:15:18 PM Eastern Daylight Time	07/18/2018 01:59:59 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-026 (HMO)	01	01		1			H5619	026	0	2019	San Joaquin County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	029	0	1	01	01	H5619_029_0	6	1				07/18/2018	2019.01	07/18/2018 05:25:24 PM Eastern Daylight Time	07/18/2018 02:00:35 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-029 (HMO)	01	01		1			H5619	029	0	2019	Contra Costa County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	032	0	1	01	01	H5619_032_0	6	1				07/18/2018	2019.01	07/18/2018 05:26:08 PM Eastern Daylight Time	07/18/2018 01:58:40 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-032 (HMO)	01	01		1			H5619	032	0	2019	Stanislaus County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	037	0	1	01	01	H5619_037_0	6	1				07/02/2018	2019.01	07/02/2018 03:48:04 PM Eastern Daylight Time	07/18/2018 02:02:35 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5619-037 (HMO)	01	01		1			H5619	037	0	2019	Select Counties in California		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	038	0	1	01	01	H5619_038_0	5	1	2	1		07/16/2018	2019.01	07/16/2018 12:35:07 PM Eastern Daylight Time	07/18/2018 02:08:00 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-038 (HMO SNP)	01	01		1			H5619	038	0	2019	Select Counties in California		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	039	1	1	01	01	H5619_039_1	5	1				07/02/2018	2019.01	07/02/2018 01:07:07 PM Eastern Daylight Time	07/18/2018 02:03:48 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-039 (HMO)	01	01		1			H5619	039	1	2019	Riverside and San Bernardino counties	Riverside County	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	039	2	1	01	01	H5619_039_2	5	1				07/02/2018	2019.01	07/02/2018 01:08:58 PM Eastern Daylight Time	07/18/2018 02:04:33 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-039 (HMO)	01	01		1			H5619	039	2	2019	Riverside and San Bernardino counties	San Bernardino County	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	040	1	1	01	01	H5619_040_1	5	1				07/02/2018	2019.01	07/02/2018 12:04:46 PM Eastern Daylight Time	06/01/2018 03:13:09 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:58:51 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-040 (HMO)	01	01		1			H5619	040	1	2019	Select Counties in Maine and New Hampshire	Select Counties in Maine and New Hampshire	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	040	2	1	01	01	H5619_040_2	4	1				07/02/2018	2019.01	07/02/2018 12:05:01 PM Eastern Daylight Time	06/01/2018 03:10:48 PM Eastern Daylight Time	08/03/2018 09:21:16 AM Eastern Daylight Time			08/06/2018 10:03:25 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-040 (HMO)	01	01		1			H5619	040	2	2019	Select Counties in Maine and New Hampshire	Select Counties in Maine and New Hampshire	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	040	3	1	01	01	H5619_040_3	4	1				07/02/2018	2019.01	07/02/2018 12:05:14 PM Eastern Daylight Time	06/01/2018 03:13:37 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:03:25 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-040 (HMO)	01	01		1			H5619	040	3	2019	Select Counties in Maine and New Hampshire	Kennebec County	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	041	0	1	01	01	H5619_041_0	4	1				07/02/2018	2019.01	07/02/2018 12:24:40 PM Eastern Daylight Time	08/03/2018 09:54:19 AM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:17:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-041 (HMO)	01	01		1			H5619	041	0	2019	Albemarle and Charlottesville City Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	042	1	1	01	01	H5619_042_1	4	1				07/03/2018	2019.01	07/03/2018 10:33:35 AM Eastern Daylight Time	07/17/2018 10:17:22 AM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:17:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-042 (HMO)	01	01		1			H5619	042	1	2019	Roanoke Metro Area	Roanoke Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	042	2	1	01	01	H5619_042_2	4	1				07/03/2018	2019.01	07/03/2018 10:38:51 AM Eastern Daylight Time	07/17/2018 10:17:54 AM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:17:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-042 (HMO)	01	01		1			H5619	042	2	2019	Roanoke Metro Area	Roanoke Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	044	0	1	01	01	H5619_044_0	5	1				07/03/2018	2019.01	07/03/2018 10:40:38 AM Eastern Daylight Time	07/17/2018 10:07:50 AM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:17:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-044 (HMO)	01	01		1			H5619	044	0	2019	Richmond Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	045	0	1	01	01	H5619_045_0	4	1				07/02/2018	2019.01	07/02/2018 12:32:00 PM Eastern Daylight Time	07/17/2018 10:10:25 AM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:17:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-045 (HMO)	01	01		1			H5619	045	0	2019	Tidewater Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	046	0	1	01	01	H5619_046_0	5	1		1		07/18/2018	2019.01	07/18/2018 05:14:37 PM Eastern Daylight Time	07/16/2018 01:05:07 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:17:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H5619	046	0	2019	Richmond - Tidewater Area		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	047	0	1	01	01	H5619_047_0	5	1				07/18/2018	2019.01	07/18/2018 05:16:08 PM Eastern Daylight Time	07/17/2018 10:12:38 AM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:17:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-047 (HMO)	01	01		1			H5619	047	0	2019	Northern Virginia Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;7a;7g;8a1;8b3;	
H5619	049	0	1	01	01	H5619_049_0	4	1				07/18/2018	2019.01	07/18/2018 05:27:52 PM Eastern Daylight Time	06/01/2018 01:00:48 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-049 (HMO)	01	01		1			H5619	049	0	2019	Indianapolis Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	050	0	1	01	01	H5619_050_0	4	1				07/18/2018	2019.01	07/18/2018 05:26:39 PM Eastern Daylight Time	08/03/2018 01:36:21 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-050 (HMO)	01	01		1			H5619	050	0	2019	Evansville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	051	0	1	01	01	H5619_051_0	4	1				07/18/2018	2019.01	07/18/2018 05:25:09 PM Eastern Daylight Time	06/01/2018 01:06:29 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-051 (HMO)	01	01		1			H5619	051	0	2019	Fort Wayne Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	052	0	1	01	01	H5619_052_0	4	1				07/18/2018	2019.01	07/18/2018 05:23:44 PM Eastern Daylight Time	06/01/2018 01:09:46 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-052 (HMO)	01	01		1			H5619	052	0	2019	South Bend Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	053	0	1	01	01	H5619_053_0	4	1				07/18/2018	2019.01	07/18/2018 05:22:02 PM Eastern Daylight Time	06/01/2018 01:16:57 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-053 (HMO)	01	01		1			H5619	053	0	2019	Lake and Porter County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	054	0	1	01	01	H5619_054_0	3	1	2	1		07/03/2018	2019.01	07/03/2018 02:27:00 PM Eastern Daylight Time	08/03/2018 01:38:07 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-054 (HMO SNP)	01	01		1			H5619	054	0	2019	Select counties in Indiana		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	055	0	1	01	01	H5619_055_0	5	1		1		07/03/2018	2019.01	07/03/2018 02:24:51 PM Eastern Daylight Time	06/01/2018 01:13:23 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H5619	055	0	2019	Select counties in Kentucky and Indiana		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	056	0	1	01	01	H5619_056_0	3	1				07/02/2018	2019.01	07/02/2018 02:30:02 PM Eastern Daylight Time	06/01/2018 02:29:19 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-056 (HMO)	01	01		1			H5619	056	0	2019	Clark County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	057	0	1	01	01	H5619_057_0	3	1				07/02/2018	2019.01	07/02/2018 02:30:40 PM Eastern Daylight Time	06/01/2018 02:32:08 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-057 (HMO)	01	01		1			H5619	057	0	2019	King County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	059	0	1	01	01	H5619_059_0	3	1				07/02/2018	2019.01	07/02/2018 02:31:23 PM Eastern Daylight Time	06/01/2018 02:29:47 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-059 (HMO)	01	01		1			H5619	059	0	2019	Snohomish County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	060	0	1	01	01	H5619_060_0	3	1				07/02/2018	2019.01	07/02/2018 02:46:39 PM Eastern Daylight Time	06/01/2018 02:30:15 PM Eastern Daylight Time	08/03/2018 09:21:17 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-060 (HMO)	01	01		1			H5619	060	0	2019	Spokane County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	061	0	1	01	01	H5619_061_0	5	1				08/06/2018	2019.01	08/06/2018 11:05:28 AM Eastern Daylight Time	06/01/2018 02:34:02 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-061 (HMO)	01	01		1			H5619	061	0	2019	Pierce County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	062	0	1	01	01	H5619_062_0	3	1				07/02/2018	2019.01	07/02/2018 02:47:16 PM Eastern Daylight Time	06/01/2018 02:34:30 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-062 (HMO)	01	01		1			H5619	062	0	2019	Thurston County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	063	0	1	01	01	H5619_063_0	3	1				07/02/2018	2019.01	07/02/2018 02:47:40 PM Eastern Daylight Time	06/01/2018 02:35:00 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-063 (HMO)	01	01		1			H5619	063	0	2019	Snohomish County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	064	0	1	01	01	H5619_064_0	4	1				07/02/2018	2019.01	07/02/2018 12:41:37 PM Eastern Daylight Time	06/01/2018 02:35:56 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-064 (HMO)	01	01		1			H5619	064	0	2019	Thurston County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	065	0	1	01	01	H5619_065_0	3	1				07/02/2018	2019.01	07/02/2018 04:00:46 PM Eastern Daylight Time	06/01/2018 03:12:13 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:03:25 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5619-065 (HMO)	01	01		1			H5619	065	0	2019	Select Counties in New Hampshire		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	066	0	1	01	01	H5619_066_0	3	1				07/02/2018	2019.01	07/02/2018 12:06:59 PM Eastern Daylight Time	08/03/2018 05:22:22 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:03:25 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-066 (HMO)	01	01		1			H5619	066	0	2019	Select Counties in Maine		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	067	0	1	01	01	H5619_067_0	5	1	2	1		07/16/2018	2019.01	07/16/2018 12:59:21 PM Eastern Daylight Time	08/03/2018 02:10:43 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-067 (HMO SNP)	01	01		1			H5619	067	0	2019	Select counties in Washington		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	069	0	1	01	01	H5619_069_0	3	1				07/02/2018	2019.01	07/02/2018 01:10:27 PM Eastern Daylight Time	06/01/2018 02:58:40 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-069 (HMO)	01	01		1			H5619	069	0	2019	Select counties in Arkansas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	070	1	1	01	01	H5619_070_1	4	1				07/18/2018	2019.01	07/18/2018 04:52:00 PM Eastern Daylight Time	08/03/2018 06:09:59 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-070 (HMO)	01	01		1			H5619	070	1	2019	Select counties in Arkansas	Select counties in Arkansas	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	070	2	1	01	01	H5619_070_2	3	1				07/03/2018	2019.01	07/03/2018 03:40:30 PM Eastern Daylight Time	08/03/2018 06:17:07 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-070 (HMO)	01	01		1			H5619	070	2	2019	Select counties in Arkansas	Select counties in Arkansas	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	071	0	1	01	01	H5619_071_0	4	1				07/18/2018	2019.01	07/18/2018 05:45:01 PM Eastern Daylight Time	06/01/2018 01:32:36 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-071 (HMO)	01	01		1			H5619	071	0	2019	Lexington Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	073	0	1	01	01	H5619_073_0	5	1				07/18/2018	2019.01	07/18/2018 05:46:50 PM Eastern Daylight Time	06/01/2018 01:32:09 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-073 (HMO)	01	01		1			H5619	073	0	2019	Louisville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	075	0	1	01	01	H5619_075_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:25:18 PM Eastern Daylight Time	07/18/2018 03:05:57 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-075 (HMO SNP)	01	01		1			H5619	075	0	2019	Central Kentucky Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	076	0	1	01	01	H5619_076_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:26:23 PM Eastern Daylight Time	07/18/2018 03:06:27 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-076 (HMO SNP)	01	01		1			H5619	076	0	2019	Clark and Floyd counties		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	077	0	1	01	01	H5619_077_0	4	1				07/02/2018	2019.01	07/02/2018 12:43:27 PM Eastern Daylight Time	06/01/2018 02:28:24 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-077 (HMO)	01	01		1			H5619	077	0	2019	Ada, Canyon and Payette counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	078	0	1	01	01	H5619_078_0	4	1				07/02/2018	2019.01	07/02/2018 12:43:48 PM Eastern Daylight Time	06/01/2018 02:28:51 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-078 (HMO)	01	01		1			H5619	078	0	2019	Bonner and Kootenai counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	079	0	1	01	01	H5619_079_0	4	1				07/02/2018	2019.01	07/02/2018 12:44:04 PM Eastern Daylight Time	06/01/2018 02:35:28 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-079 (HMO)	01	01		1			H5619	079	0	2019	Ada, Canyon and Payette counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	080	0	1	01	01	H5619_080_0	4	1				07/16/2018	2019.01	07/16/2018 01:21:54 PM Eastern Daylight Time	07/18/2018 02:09:13 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:00:02 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-080 (HMO)	01	01		1			H5619	080	0	2019	Richland County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	081	0	1	01	01	H5619_081_0	3	1				07/02/2018	2019.01	07/02/2018 12:57:23 PM Eastern Daylight Time	06/01/2018 03:10:11 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-081 (HMO)	01	01		1			H5619	081	0	2019	Richland County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	082	0	1	01	01	H5619_082_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 01:35:13 PM Eastern Daylight Time	08/03/2018 01:33:55 PM Eastern Daylight Time	08/03/2018 09:21:18 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-082 (HMO SNP)	01	01		1			H5619	082	0	2019	Greater South Carolina		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	083	0	1	01	01	H5619_083_0	6	1				07/02/2018	2019.01	07/02/2018 01:05:47 PM Eastern Daylight Time	06/01/2018 03:04:54 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-083 (HMO)	01	01		1			H5619	083	0	2019	Charleston Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	084	0	1	01	01	H5619_084_0	4	1				07/02/2018	2019.01	07/02/2018 01:06:32 PM Eastern Daylight Time	06/01/2018 03:11:12 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-084 (HMO)	01	01		1			H5619	084	0	2019	Charleston Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	086	0	1	01	01	H5619_086_0	4	1				07/02/2018	2019.01	07/02/2018 01:07:23 PM Eastern Daylight Time	06/01/2018 03:17:47 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-086 (HMO)	01	01		1			H5619	086	0	2019	Spartanburg/Greenville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	087	0	1	01	01	H5619_087_0	4	1		1		07/02/2018	2019.01	07/02/2018 01:08:27 PM Eastern Daylight Time	06/01/2018 03:09:10 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H5619	087	0	2019	Upstate South Carolina		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	088	0	1	01	01	H5619_088_0	4	1				07/19/2018	2019.01	07/19/2018 04:27:29 PM Eastern Daylight Time	06/01/2018 01:31:34 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-088 (HMO)	01	01		1			H5619	088	0	2019	Birmingham Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	089	0	1	01	01	H5619_089_0	4	1				07/18/2018	2019.01	07/18/2018 05:48:43 PM Eastern Daylight Time	06/01/2018 01:32:02 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-089 (HMO)	01	01		1			H5619	089	0	2019	Mobile Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	090	0	1	01	01	H5619_090_0	3	1				07/03/2018	2019.01	07/03/2018 09:26:24 AM Eastern Daylight Time	06/01/2018 01:32:29 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-090 (HMO)	01	01		1			H5619	090	0	2019	Select VA Counties in the Tri-Cities Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	091	0	1	01	01	H5619_091_0	3	1				07/03/2018	2019.01	07/03/2018 09:26:35 AM Eastern Daylight Time	08/03/2018 12:19:05 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-091 (HMO)	01	01		1			H5619	091	0	2019	Select VA Counties in the Tri-Cities Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	093	0	1	01	01	H5619_093_0	5	1	2	1		07/17/2018	2019.01	07/17/2018 01:33:24 PM Eastern Daylight Time	07/17/2018 05:55:32 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-093 (HMO SNP)	01	01		1			H5619	093	0	2019	Greater Alabama		2		2			1	3		2		2	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	094	0	1	01	01	H5619_094_0	4	1				07/18/2018	2019.01	07/18/2018 05:50:50 PM Eastern Daylight Time	06/01/2018 01:33:50 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-094 (HMO)	01	01		1			H5619	094	0	2019	Huntsville Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	095	0	1	01	01	H5619_095_0	3	1				07/03/2018	2019.01	07/03/2018 09:27:02 AM Eastern Daylight Time	06/01/2018 01:37:20 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:58:07 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-095 (HMO)	01	01		1			H5619	095	0	2019	Select VA Counties in the Tri-Cities Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	097	0	1	01	01	H5619_097_0	4	1				07/02/2018	2019.01	07/02/2018 12:44:23 PM Eastern Daylight Time	06/01/2018 02:36:25 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-097 (HMO)	01	01		1			H5619	097	0	2019	King County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	099	0	1	01	01	H5619_099_0	4	1				07/02/2018	2019.01	07/02/2018 12:44:42 PM Eastern Daylight Time	06/01/2018 02:38:46 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 11:08:29 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-099 (HMO)	01	01		1			H5619	099	0	2019	Kitsap County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	100	0	1	01	01	H5619_100_0	4	1				07/02/2018	2019.01	07/02/2018 12:44:59 PM Eastern Daylight Time	06/01/2018 02:36:54 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 11:12:55 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-100 (HMO)	01	01		1			H5619	100	0	2019	Pierce County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	101	0	1	01	01	H5619_101_0	4	1				07/02/2018	2019.01	07/02/2018 12:45:19 PM Eastern Daylight Time	06/01/2018 02:37:21 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 11:12:55 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-101 (HMO)	01	01		1			H5619	101	0	2019	Clark County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	102	0	1	01	01	H5619_102_0	4	1				07/02/2018	2019.01	07/02/2018 12:45:36 PM Eastern Daylight Time	06/01/2018 02:37:49 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 11:12:55 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-102 (HMO)	01	01		1			H5619	102	0	2019	Spokane County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	104	0	1	01	01	H5619_104_0	4	1				07/02/2018	2019.01	07/02/2018 12:45:58 PM Eastern Daylight Time	06/01/2018 02:38:18 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 11:12:55 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-104 (HMO)	01	01		1			H5619	104	0	2019	Kitsap County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	109	0	1	01	01	H5619_109_0	3	1				08/01/2018	2019.01	08/01/2018 03:31:33 PM Eastern Daylight Time	08/03/2018 06:14:35 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:16:02 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5619-109 (HMO)	01	01		1			H5619	109	0	2019	Select counties in Arkansas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	110	0	1	01	01	H5619_110_0	4	1				07/02/2018	2019.01	07/02/2018 01:09:38 PM Eastern Daylight Time	06/01/2018 03:26:31 PM Eastern Daylight Time	08/03/2018 09:21:19 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-110 (HMO)	01	01		1			H5619	110	0	2019	Select Counties in South Carolina		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	111	0	1	01	01	H5619_111_0	3	1				07/03/2018	2019.01	07/03/2018 03:39:27 PM Eastern Daylight Time	06/01/2018 03:01:59 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:21:17 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-111 (HMO)	01	01		1			H5619	111	0	2019	Northwest Arkansas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	112	0	1	01	01	H5619_112_0	4	1				07/18/2018	2019.01	07/18/2018 05:10:52 PM Eastern Daylight Time	06/01/2018 01:39:59 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-112 (HMO)	01	01		1			H5619	112	0	2019	Select Counties in Alabama		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	113	0	1	01	01	H5619_113_0	5	1				07/18/2018	2019.01	07/18/2018 05:54:14 PM Eastern Daylight Time	07/18/2018 03:06:57 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 11:16:16 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-113 (HMO)	01	01		1			H5619	113	0	2019	Select counties in West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	114	0	1	01	01	H5619_114_0	3	1				07/02/2018	2019.01	07/02/2018 02:48:12 PM Eastern Daylight Time	06/01/2018 02:40:10 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:43:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-114 (HMO)	01	01		1			H5619	114	0	2019	Whatcom and Skagit Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	115	0	1	01	01	H5619_115_0	3	1				07/02/2018	2019.01	07/02/2018 02:48:38 PM Eastern Daylight Time	06/01/2018 02:40:38 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:43:11 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-115 (HMO)	01	01		1			H5619	115	0	2019	Whatcom and Skagit Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	116	0	1	01	01	H5619_116_0	6	1				07/18/2018	2019.01	07/18/2018 05:24:14 PM Eastern Daylight Time	07/18/2018 02:07:17 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:44 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-116 (HMO)	01	01		1			H5619	116	0	2019	Kern County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	802	0	1	01	01	H5619_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:43:42 PM Eastern Daylight Time					05/31/2018 01:46:43 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	802	0	2019	Select Counties in Multi States		1	1279	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5619	803	0	1	01	01	H5619_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:44:31 PM Eastern Daylight Time					05/31/2018 01:46:43 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	803	0	2019	Select Counties in Multi States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5628	001	0	1	01	01	H5628_001_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 11:01:39 AM Pacific Daylight Time	08/04/2018 10:14:46 AM Pacific Daylight Time	08/04/2018 11:14:54 AM Pacific Daylight Time			08/10/2018 10:31:59 AM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5628	001	0	2019	Salt Lake City		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(888)665-1328		(888)665-1328		(866)403-8293		(866)403-8293		(888)665-1328		(888)665-1328		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	006	0	1	01	01	H5628_006_0	4	1	2	1		08/06/2018	2019.01	08/06/2018 11:02:39 AM Pacific Daylight Time	08/04/2018 10:16:08 AM Pacific Daylight Time	08/04/2018 11:15:26 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.uhealthplan.utah.edu/healthy_advantage.html	Healthy Advantage (HMO SNP)	01	01		1			H5628	006	0	2019	Salt Lake City		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.uhealthplan.utah.edu/healthy_advantage.html	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	007	0	1	01	01	H5628_007_0	6	1				07/18/2018	2019.01	07/18/2018 03:01:47 PM Pacific Daylight Time	08/04/2018 10:18:20 AM Pacific Daylight Time	08/04/2018 11:15:58 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.healthyadvantageplus.org	Healthy Advantage Plus (HMO)	01	01		1			H5628	007	0	2019	Salt Lake City		2		2			2						www.molinahealthcare.com/medicare	www.healthyadvantageplus.org	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	008	0	1	01	01	H5628_008_0	3	1	2	1		06/01/2018	2019.01	06/01/2018 10:53:17 AM Pacific Daylight Time	08/04/2018 10:19:36 AM Pacific Daylight Time	08/04/2018 11:16:34 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5628	008	0	2019	Idaho		2		2			1	3		1		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)239-4913		(844)239-4913		(866)403-8293		(866)403-8293		(844)239-4913		(844)239-4913		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	009	0	1	01	01	H5628_009_0	4	1				07/18/2018	2019.01	07/18/2018 02:06:54 PM Pacific Daylight Time	08/04/2018 10:21:00 AM Pacific Daylight Time	08/04/2018 11:17:10 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Options (HMO)	01	01		1			H5628	009	0	2019	Boise		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	010	0	1	01	01	H5628_010_0	5	1				07/18/2018	2019.01	07/18/2018 02:08:10 PM Pacific Daylight Time	08/06/2018 11:36:16 AM Pacific Daylight Time	08/04/2018 11:17:54 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Options (HMO)	01	01		1			H5628	010	0	2019	Twin Falls		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5629	001	0	1	20	08	H5629_001_0	1	1				05/22/2018	2019.01	05/22/2018 05:38:06 PM Pacific Daylight Time		05/22/2018 05:30:59 PM Pacific Daylight Time			05/22/2018 05:41:20 PM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	08	20		1			H5629	001	0	2019	San Diego County, South County, East County		2		2			2						stpaulspace.org	stpaulspace.org										(619)677-3800		(619)677-3800		(619)677-3800		(619)677-3800										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5629	002	0	1	20	08	H5629_002_0	1	1				05/22/2018	2019.01	05/22/2018 05:38:46 PM Pacific Daylight Time		05/22/2018 05:31:00 PM Pacific Daylight Time			05/22/2018 05:41:20 PM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	08	20		1			H5629	002	0	2019	San Diego County, South County, East County		2		2			2						stpaulspace.org	stpaulspace.org										(619)271-7100		(619)271-7100		(619)271-7100		(619)271-7100										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5644	002	0	1	01	01	H5644_002_0	6	1				07/05/2018	2019.01	07/05/2018 09:19:05 AM Central Daylight Time	07/31/2018 04:30:42 PM Central Daylight Time	08/03/2018 09:59:43 AM Central Daylight Time			08/03/2018 10:41:40 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network Health Medicare Explore (HMO)	01	01		1			H5644	002	0	2019	Southeast Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2	2			
H5649	001	0	1	01	01	H5649_001_0	5	1				08/06/2018	2019.01	08/06/2018 05:25:38 PM Eastern Daylight Time	08/02/2018 06:13:30 PM Eastern Daylight Time	08/02/2018 05:50:48 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medicare Plan (HMO)	01	01		1			H5649	001	0	2019	Counties:  LA, SB, RS,  partial OC		2	304548	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	002	0	1	01	01	H5649_002_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 05:26:18 PM Eastern Daylight Time	08/02/2018 06:15:04 PM Eastern Daylight Time	08/02/2018 05:52:21 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medi-Medi Plan (HMO SNP)	01	01		1			H5649	002	0	2019	Counties: LA and SB		2	42813	2			1	3		1		2	www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	004	0	1	01	01	H5649_004_0	5	1				08/06/2018	2019.01	08/06/2018 05:26:57 PM Eastern Daylight Time	08/02/2018 06:16:37 PM Eastern Daylight Time	08/02/2018 05:53:55 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan (HMO)	01	01		1			H5649	004	0	2019	Counties:  LA, SB, RS and partial OC		2	126975	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	006	0	1	01	01	H5649_006_0	6	1		1		08/06/2018	2019.01	08/06/2018 05:27:45 PM Eastern Daylight Time	08/02/2018 06:18:16 PM Eastern Daylight Time	08/02/2018 05:54:58 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Focus Plan (HMO SNP)	01	01		1			H5649	006	0	2019	Counties:  LA, SB, and partial OC		2	33900	2			1	4			00000000000000000010		www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	008	0	1	01	01	H5649_008_0	4	1				05/30/2018	2019.01	05/30/2018 12:50:01 PM Eastern Daylight Time	08/02/2018 06:19:46 PM Eastern Daylight Time	08/02/2018 05:56:18 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Medicare Plan (HMO)	01	01		1			H5649	008	0	2019	Ventura County		2	7263	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	009	0	1	01	01	H5649_009_0	4	1	2	1		05/25/2018	2019.01	05/25/2018 09:58:01 PM Eastern Daylight Time	08/06/2018 06:33:54 PM Eastern Daylight Time	08/02/2018 05:58:00 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Medi-Medi Plan (HMO SNP)	01	01		1			H5649	009	0	2019	Ventura County		2	8253	2			1	3		1		2	www.centralhealthplan.com/Benefits/Pharmacy.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	013	0	1	01	01	H5649_013_0	5	1				08/06/2018	2019.01	08/06/2018 05:28:43 PM Eastern Daylight Time	08/02/2018 06:23:52 PM Eastern Daylight Time	08/02/2018 05:59:19 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Inspire HMO (HMO)	01	01		1			H5649	013	0	2019	Counties: San Benito and San Joaquin		2	304548	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	014	0	1	01	01	H5649_014_0	5	1	2	1		07/05/2018	2019.01	07/05/2018 07:00:43 PM Eastern Daylight Time	08/06/2018 06:36:19 PM Eastern Daylight Time	08/02/2018 06:00:30 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Elite HMO SNP (HMO SNP)	01	01		1			H5649	014	0	2019	Counties: San Benito and San Joaquin		2	42813	2			1	3		1		2	www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	016	0	1	01	01	H5649_016_0	5	1				08/06/2018	2019.01	08/06/2018 05:29:12 PM Eastern Daylight Time	08/02/2018 06:28:21 PM Eastern Daylight Time	08/02/2018 06:01:37 PM Eastern Daylight Time			08/07/2018 11:39:05 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Prestige HMO (HMO)	01	01		1			H5649	016	0	2019	Counties: San Benito and San Joaquin		2	126975	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/NetworkProviders/Directory.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5652	001	0	1	02	01	H5652_001_0	2	1				05/30/2018	2019.01	05/30/2018 09:39:48 AM Central Daylight Time	08/03/2018 10:28:13 AM Central Daylight Time	07/31/2018 07:49:00 PM Central Daylight Time			08/06/2018 01:26:31 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Signature with Drugs (HMO-POS)	01	02		1			H5652	001	0	2019	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			2						www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	002	0	1	02	01	H5652_002_0	1	1				05/28/2018	2019.01	05/28/2018 01:53:28 PM Central Daylight Time	06/01/2018 04:15:03 PM Central Daylight Time				06/02/2018 12:08:18 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Signature without Drugs (HMO-POS)	01	02		1			H5652	002	0	2019	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			2						www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5652	003	0	1	02	01	H5652_003_0	2	1		1		08/06/2018	2019.01	08/06/2018 10:35:48 AM Central Daylight Time	08/03/2018 10:29:44 AM Central Daylight Time	07/31/2018 07:49:24 PM Central Daylight Time			08/06/2018 01:26:31 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Guardian (HMO-POS SNP)	01	02		1			H5652	003	0	2019	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			1	1	1				www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	004	0	1	02	01	H5652_004_0	2	1		1		05/30/2018	2019.01	05/30/2018 09:40:19 AM Central Daylight Time	08/03/2018 10:30:11 AM Central Daylight Time	07/31/2018 07:49:56 PM Central Daylight Time			08/06/2018 02:38:06 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Champion (HMO-POS SNP)	01	02		1			H5652	004	0	2019	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			1	4			00011010000000000000		www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	006	0	1	02	01	H5652_006_0	3	1				05/30/2018	2019.01	05/30/2018 09:40:56 AM Central Daylight Time	08/03/2018 10:30:42 AM Central Daylight Time	07/31/2018 07:50:18 PM Central Daylight Time			08/06/2018 02:38:06 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Freedom (HMO-POS)	01	02		1			H5652	006	0	2019	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC		2		2			2						www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5656	001	0	1	01	01	H5656_001_0	6	1				08/03/2018	2019.01	08/03/2018 12:08:41 PM Eastern Daylight Time	08/06/2018 05:57:36 PM Eastern Daylight Time	08/01/2018 02:47:40 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	01	01		1			H5656	001	0	2019	Dallas/Fort Worth Area		2	49864	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5656	801	0	1	01	01	H5656_801_0	3	1				05/30/2018	2019.01	05/30/2018 10:35:25 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	Retiree - MA-PD CY (HMO)	01	01		1			H5656	801	0	2019	Employer Group--North Texas (MAPD--CY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5656	802	0	1	01	01	H5656_802_0	3	1				05/30/2018	2019.01	05/30/2018 10:37:44 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	Retiree - MA-PD non-CY (HMO)	01	01		1			H5656	802	0	2019	Employer Group--North Texas (MAPD--non-CY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5656	803	0	1	01	01	H5656_803_0	3	1				05/30/2018	2019.01	05/30/2018 10:51:29 AM Eastern Daylight Time					06/02/2018 04:04:24 PM Eastern Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American, A WellCare Company	www.wellcare.com/medicare	Retiree - MA (HMO)	01	01		1			H5656	803	0	2019	Employer Group--North Texas (MA--CY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5703	001	0	1	01	01	H5703_001_0	3	1	2	1		05/31/2018	2019.01	05/31/2018 11:04:23 AM Central Daylight Time	08/01/2018 03:41:20 PM Central Daylight Time	08/01/2018 02:50:26 PM Central Daylight Time			08/02/2018 03:49:01 PM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	AbilityCare (HMO SNP)	01	01		1			H5703	001	0	2019	Select Counties in Minnesota		2	8113	1	1		1	3		1		1	www.mnscha.org	www.mnscha.org	www.mnscha.org	(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5742	001	0	1	01	01	H5742_001_0	6	1	2	1		08/07/2018	2019.01	08/07/2018 09:14:23 AM Central Daylight Time	08/06/2018 09:49:06 AM Central Daylight Time	08/03/2018 02:51:52 PM Central Daylight Time			08/07/2018 09:16:16 AM Central Daylight Time	SHA, LLC	FirstCare Advantage	www.firstcare.com/dualsnp	FirstCare Advantage Dual SNP (HMO SNP)	01	01		1			H5742	001	0	2019	FirstCare Advantage Dual SNP		2	3000	1	1		1	3		1		1	www.firstcare.com/dualsnp	www.firstcare.com/dualsnp	www.firstcare.com/dualsnp	(866)229-4969		(806)784-4300		(866)229-4969		(806)784-4300		(866)229-4969		(806)784-4300		(866)229-4969		(806)784-4300		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					1	2			
H5746	016	0	1	01	01	H5746_016_0	8	1				08/02/2018	2019.01	08/02/2018 12:15:04 PM Pacific Daylight Time	08/05/2018 10:27:28 PM Pacific Daylight Time	08/01/2018 05:19:03 PM Pacific Daylight Time			08/06/2018 03:26:51 PM Pacific Daylight Time	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Amerigroup Community Care of New Mexico	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5746	016	0	2019	Greater Albuquerque Area		2	15694	2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)726-6749		(844)726-6749		(866)805-4589		(866)805-4589		(844)726-6750		(844)726-6750		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5774	003	0	1	01	01	H5774_003_0	7	1				07/19/2018	2019.01	07/19/2018 03:53:59 PM SA Western Standard Time	07/12/2018 03:45:02 PM SA Western Standard Time				07/26/2018 12:11:38 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Basic (HMO)	01	01		1			H5774	003	0	2019	Puerto Rico		2	4625	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2					2	1	11	7d;7f;7g;8a1;8a2;8b1;18a;	7f;18a1;18a2;
H5774	005	0	1	01	01	H5774_005_0	10	1				08/03/2018	2019.01	08/03/2018 09:10:26 AM SA Western Standard Time	08/03/2018 02:22:27 PM SA Western Standard Time	08/01/2018 09:31:27 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal (HMO)	01	01		1			H5774	005	0	2019	Puerto Rico		2	253060	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	1	11	7d;7f;7g;8a1;8a2;8b1;	7f;
H5774	022	0	1	01	01	H5774_022_0	9	1		1		08/03/2018	2019.01	08/03/2018 09:15:09 AM SA Western Standard Time	08/03/2018 02:23:12 PM SA Western Standard Time	08/01/2018 09:31:51 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Vital Plus (HMO SNP)	01	01		1			H5774	022	0	2019	Puerto Rico		2	27750	2			1	4			00000000000000000010		www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	1	11	7d;7f;7g;8a1;8a2;8b1;18a;	7f;18a1;18a2;
H5774	023	0	1	02	01	H5774_023_0	10	1				08/03/2018	2019.01	08/03/2018 09:11:02 AM SA Western Standard Time	08/03/2018 02:23:56 PM SA Western Standard Time	08/01/2018 09:32:16 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal Plus (HMO-POS)	01	02		1			H5774	023	0	2019	Puerto Rico		2	37971	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	1	11	7d;7f;7g;8a1;8a2;8b1;	7f;
H5774	024	0	1	01	01	H5774_024_0	9	1	1	1		08/03/2018	2019.01	08/03/2018 09:04:40 AM SA Western Standard Time	08/03/2018 02:24:42 PM SA Western Standard Time	08/01/2018 09:32:40 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Plus (HMO SNP)	01	01		1			H5774	024	0	2019	Puerto Rico		2	422233	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	2			
H5774	025	0	1	01	01	H5774_025_0	9	1	1	1		08/03/2018	2019.01	08/03/2018 09:05:30 AM SA Western Standard Time	08/03/2018 02:25:26 PM SA Western Standard Time	08/01/2018 09:33:04 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Ultra (HMO SNP)	01	01		1			H5774	025	0	2019	Puerto Rico		2	143711	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	2			
H5774	026	0	1	01	01	H5774_026_0	11	1	1	1		08/03/2018	2019.01	08/03/2018 09:06:01 AM SA Western Standard Time	08/03/2018 02:26:14 PM SA Western Standard Time	08/01/2018 09:33:29 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Advance (HMO SNP)	01	01		1			H5774	026	0	2019	Puerto Rico		2	8849	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	1	01	7d;7f;8a1;8a2;8b1;8b2;8b3;	
H5774	027	0	1	02	01	H5774_027_0	9	1				08/03/2018	2019.01	08/03/2018 09:11:37 AM SA Western Standard Time	08/03/2018 02:26:57 PM SA Western Standard Time	08/01/2018 09:33:53 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Magno (HMO-POS)	01	02		1			H5774	027	0	2019	Puerto Rico		2	129115	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	1	11	7d;7f;7g;8b1;	7f;
H5774	028	0	1	01	01	H5774_028_0	9	1	1	1		08/03/2018	2019.01	08/03/2018 09:06:41 AM SA Western Standard Time	08/03/2018 02:27:43 PM SA Western Standard Time	08/01/2018 09:34:17 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Blindao (HMO SNP)	01	01		1			H5774	028	0	2019	Puerto Rico		2	234517	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2	2			
H5774	029	0	1	02	01	H5774_029_0	9	1				08/03/2018	2019.01	08/03/2018 09:12:30 AM SA Western Standard Time	08/03/2018 02:28:32 PM SA Western Standard Time	08/01/2018 09:34:42 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Titn (HMO-POS)	01	02		1			H5774	029	0	2019	Puerto Rico		2	48000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					1	2		2		2	2			
H5774	030	0	1	02	01	H5774_030_0	9	1				08/03/2018	2019.01	08/03/2018 09:21:14 AM SA Western Standard Time	08/03/2018 02:29:16 PM SA Western Standard Time	08/01/2018 09:35:07 AM SA Western Standard Time			08/03/2018 04:21:14 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Titn+ (HMO-POS)	01	02		1			H5774	030	0	2019	Puerto Rico		2	12000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					1	2		2		2	2			
H5774	802	0	1	01	01	H5774_802_0	6	1				06/04/2018	2019.01	06/04/2018 05:20:43 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal A (HMO)	01	01		1			H5774	802	0	2019	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					1				
H5774	806	0	1	01	01	H5774_806_0	6	1				06/04/2018	2019.01	06/04/2018 05:21:04 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal B (HMO)	01	01		1			H5774	806	0	2019	Puerto Rico		1	2547	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					1				
H5774	808	0	1	01	01	H5774_808_0	6	1				06/04/2018	2019.01	06/04/2018 05:21:27 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal C (HMO)	01	01		1			H5774	808	0	2019	Puerto Rico		1	13195	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					1				
H5774	809	0	1	02	01	H5774_809_0	6	1				06/04/2018	2019.01	06/04/2018 05:21:51 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal D (HMO-POS)	01	02		1			H5774	809	0	2019	Puerto Rico		1	239642	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	2		2		1				
H5774	810	0	1	01	01	H5774_810_0	6	1				06/04/2018	2019.01	06/04/2018 05:24:15 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal E (HMO)	01	01		1			H5774	810	0	2019	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					1				
H5774	811	0	1	02	01	H5774_811_0	6	1				06/04/2018	2019.01	06/04/2018 05:24:30 PM SA Western Standard Time					07/13/2018 03:58:42 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal Plus A (HMO-POS)	01	02		1			H5774	811	0	2019	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	2		2		1				
H5779	002	0	1	01	01	H5779_002_0	4	1				07/23/2018	2019.01	07/23/2018 12:42:01 PM Eastern Daylight Time	08/02/2018 06:08:58 PM Eastern Daylight Time	08/02/2018 11:14:46 AM Eastern Daylight Time			08/07/2018 04:34:29 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5779	002	0	2019	KN, MER, PEO, RI, TA, WAR Counties		2	24816	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5779	005	0	1	01	01	H5779_005_0	4	1				07/23/2018	2019.01	07/23/2018 12:42:18 PM Eastern Daylight Time	08/02/2018 06:10:06 PM Eastern Daylight Time	08/02/2018 11:15:30 AM Eastern Daylight Time			08/07/2018 04:34:29 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Essential (HMO)	01	01		1			H5779	005	0	2019	BOO, COO, KNE, MCH, WIL, WIN Counties		2	13460	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5779	006	0	1	01	01	H5779_006_0	4	1				08/07/2018	2019.01	08/07/2018 09:33:36 AM Eastern Daylight Time	08/02/2018 06:11:14 PM Eastern Daylight Time	08/02/2018 11:16:16 AM Eastern Daylight Time			08/07/2018 04:34:29 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	MeridianCare	www.mymeridiancare.com	MeridianCare Edge (HMO)	01	01		1			H5779	006	0	2019	Greater Chicago and Central Illinois		2	9088	2			2						www.mymeridiancare.com	www.mymeridiancare.com	www.mymeridiancare.com	(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(877)902-6784		(877)902-6784		(844)949-6227		(844)949-6227		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	001	0	1	01	01	H5793_001_0	4	1				07/11/2018	2019.01	07/11/2018 02:50:39 PM Central Daylight Time	08/03/2018 10:21:57 AM Central Daylight Time	07/31/2018 10:31:46 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5793	001	0	2019	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	010	0	1	01	01	H5793_010_0	3	1				08/01/2018	2019.01	08/01/2018 04:06:11 PM Eastern Daylight Time	08/03/2018 10:22:38 AM Central Daylight Time	07/31/2018 10:32:40 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	010	0	2019	Shoreline CT		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	011	0	1	01	01	H5793_011_0	3	1				08/01/2018	2019.01	08/01/2018 04:06:29 PM Eastern Daylight Time	08/03/2018 10:23:19 AM Central Daylight Time	07/31/2018 10:33:32 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	011	0	2019	Inland CT		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	012	0	1	01	01	H5793_012_0	3	1				08/03/2018	2019.01	08/03/2018 09:04:33 AM Eastern Daylight Time	08/03/2018 10:24:03 AM Central Daylight Time	07/31/2018 10:34:24 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime PCP Elite (HMO)	01	01		1			H5793	012	0	2019	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	801	0	1	01	01	H5793_801_0	2	1				06/04/2018	2019.01	06/04/2018 10:55:11 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5793	801	0	2019	Connecticut		1	180	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H5793	802	0	1	01	01	H5793_802_0	2	1				06/04/2018	2019.01	06/04/2018 10:55:23 AM Central Daylight Time					06/04/2018 11:11:44 AM Central Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H5793	802	0	2019	Connecticut		1	510	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H5810	001	0	1	01	01	H5810_001_0	3	1	2	1		06/01/2018	2019.01	06/01/2018 03:00:51 PM Pacific Daylight Time	08/04/2018 10:25:04 AM Pacific Daylight Time	08/04/2018 11:18:48 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5810	001	0	2019	Southern California		2		2			1	3		1		1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-0898		(800)665-0898		(866)403-8293		(866)403-8293		(800)665-0898		(800)665-0898		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5822	001	0	1	20	08	H5822_001_0	2	1				05/23/2018	2019.01	05/23/2018 12:10:06 PM Central Daylight Time		05/23/2018 01:32:57 PM Central Daylight Time			05/23/2018 01:35:03 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcc.org	Midland Care Connection - Dual Eligibles (PACE)	08	20		1			H5822	001	0	2019	DG,JA,JF,LY,LV,MS,NM,OS,PT,SN,WB,WY counties		2		2			2						N/A	N/A										(800)726-7450		(785)232-2044		(800)726-7450		(785)232-2044										(711)-		(711)-		(711)-		(711)-																
H5822	002	0	1	20	08	H5822_002_0	2	1				05/23/2018	2019.01	05/23/2018 12:12:06 PM Central Daylight Time		05/23/2018 01:32:44 PM Central Daylight Time			05/23/2018 01:35:03 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcc.org	Midland Care Connection - Medicare Only (PACE)	08	20		1			H5822	002	0	2019	DG,JA,JF,LY,LV,MS,NM,OS,PT,SN,WB,WYcounties		2		2			2						N/A	N/A										(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044										(711)-		(711)-		(711)-		(711)-																
H5823	006	0	1	01	01	H5823_006_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 11:04:07 AM Pacific Daylight Time	08/04/2018 10:26:12 AM Pacific Daylight Time	08/04/2018 11:19:30 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WASHINGTON, INC.	Molina Healthcare of Washington, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5823	006	0	2019	Seattle, Tacoma, Spokane		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-1029		(800)665-1029		(866)403-8293		(866)403-8293		(800)665-1029		(800)665-1029		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	006	0	1	01	01	H5826_006_0	6	1				07/03/2018	2019.01	07/03/2018 03:08:40 PM Pacific Daylight Time	06/21/2018 08:35:55 AM Pacific Daylight Time				07/11/2018 12:35:26 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Plan (HMO)	01	01		1			H5826	006	0	2019	Western Washington and Spokane Counties		2	1187	2			2						www.healthfirst.chpw.org	www.healthfirst.chpw.org	http://healthfirst.chpw.org/	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5826	008	0	1	01	01	H5826_008_0	8	1				07/31/2018	2019.01	07/31/2018 02:06:34 PM Pacific Daylight Time	08/02/2018 09:23:20 AM Pacific Daylight Time	08/02/2018 08:45:31 AM Pacific Daylight Time			08/06/2018 02:03:55 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	01	01		1			H5826	008	0	2019	Western Washington and Spokane Counties		2	16672	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	009	0	1	01	01	H5826_009_0	8	1				07/11/2018	2019.01	07/11/2018 09:45:48 AM Pacific Daylight Time	08/02/2018 09:25:38 AM Pacific Daylight Time	08/02/2018 08:44:20 AM Pacific Daylight Time			08/06/2018 02:03:55 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	01	01		1			H5826	009	0	2019	Eastern and Western Washington State		2	9504	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	010	0	1	01	01	H5826_010_0	8	1				07/11/2018	2019.01	07/11/2018 09:46:08 AM Pacific Daylight Time	08/02/2018 09:27:26 AM Pacific Daylight Time	08/02/2018 08:46:27 AM Pacific Daylight Time			08/06/2018 02:03:55 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Extra Plan (HMO)	01	01		1			H5826	010	0	2019	Eastern and Western Washington State		2	29944	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	014	0	1	01	01	H5826_014_0	7	1	2	1		07/11/2018	2019.01	07/11/2018 09:47:47 AM Pacific Daylight Time	08/02/2018 09:29:19 AM Pacific Daylight Time	08/02/2018 08:47:25 AM Pacific Daylight Time			08/06/2018 02:03:55 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Special Needs Plan (HMO SNP)	01	01		1			H5826	014	0	2019	Eastern and Western Washington State		2	47142	2			1	3		1		1	http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	016	0	1	01	01	H5826_016_0	7	1				08/02/2018	2019.01	08/02/2018 04:56:40 PM Pacific Daylight Time	08/03/2018 02:41:03 PM Pacific Daylight Time	08/02/2018 08:48:28 AM Pacific Daylight Time			08/06/2018 02:03:55 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Value Plan (HMO) (HMO)	01	01		1			H5826	016	0	2019	Western Washington		2	6116	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	(800)944-0247		(800)944-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5852	001	0	1	01	01	H5852_001_0	4	1		1		07/02/2018	2019.01	07/02/2018 02:39:28 PM Pacific Daylight Time	08/03/2018 11:52:04 AM Pacific Daylight Time	08/03/2018 11:52:04 AM Pacific Daylight Time			08/03/2018 11:54:43 AM Pacific Daylight Time	AIDS HEALTHCARE FOUNDATION	AHF	www.php-ca.org	PHP (HMO SNP)	01	01		1			H5852	001	0	2019	Los Angeles County, California		2		2			1	4			00000000001000000000		www.php-ca.org/provider-find	www.php-ca.org/for-members/drug-benefit/formulary	www.php-ca.org/provider-find	(800)263-0067		(800)263-0067		(800)263-0067		(800)263-0067		(888)436-5018		(888)436-5018		(800)263-0067		(800)263-0067		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	007	0	1	01	01	H5854_007_0	5	1				08/03/2018	2019.01	08/03/2018 03:24:02 PM Eastern Daylight Time	08/06/2018 01:28:27 AM Eastern Daylight Time	08/01/2018 08:21:46 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	01	01		1			H5854	007	0	2019	Hartford County		2	9577	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	008	0	1	01	01	H5854_008_0	4	1	2	1		08/03/2018	2019.01	08/03/2018 03:32:34 PM Eastern Daylight Time	08/06/2018 01:29:27 AM Eastern Daylight Time	08/01/2018 08:20:56 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H5854	008	0	2019	Select Counties in Connecticut		2	226356	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)533-2091		(844)533-2091		(844)834-6071		(844)834-6071		(844)533-2091		(844)533-2091		(844)834-6072		(844)834-6072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	009	0	1	01	01	H5854_009_0	5	1				08/03/2018	2019.01	08/03/2018 03:24:41 PM Eastern Daylight Time	08/06/2018 01:30:27 AM Eastern Daylight Time	08/01/2018 08:22:32 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	01	01		1			H5854	009	0	2019	Select Counties in Connecticut		2	22409	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	010	0	1	01	01	H5854_010_0	6	1				08/03/2018	2019.01	08/03/2018 08:59:52 PM Eastern Daylight Time	08/06/2018 01:31:28 AM Eastern Daylight Time	08/01/2018 08:23:24 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Select (HMO)	01	01		1			H5854	010	0	2019	Select Counties in Connecticut		2	139524	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	011	0	1	01	01	H5854_011_0	6	1				08/03/2018	2019.01	08/03/2018 09:01:25 PM Eastern Daylight Time	08/06/2018 01:32:28 AM Eastern Daylight Time	08/01/2018 08:24:17 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Extra (HMO)	01	01		1			H5854	011	0	2019	Entire State of Connecticut		2	96	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	012	0	1	02	01	H5854_012_0	9	1		1		08/03/2018	2019.01	08/03/2018 09:35:59 PM Eastern Daylight Time		08/01/2018 08:25:09 PM Eastern Daylight Time		08/06/2018 01:33:01 AM Eastern Daylight Time	08/06/2018 06:27:08 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue ESRD (HMO-POS SNP)	01	02		1			H5854	012	0	2019	Select Counties in Connecticut		2	585	2			1	4			00000000100000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	801	0	1	01	01	H5854_801_0	2	1				06/19/2018	2019.01	06/19/2018 01:42:56 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	801	0	2019	Connecticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	803	0	1	01	01	H5854_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:44:23 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	803	0	2019	Connecticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	806	0	2	01	01	H5854_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:44:29 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		2	1		H5854	806	0	2019	Conneticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	807	0	2	01	01	H5854_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:44:42 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		2	1		H5854	807	0	2019	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	808	0	1	01	01	H5854_808_0	2	1				06/19/2018	2019.01	06/19/2018 01:45:02 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	808	0	2019	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	809	0	1	01	01	H5854_809_0	2	1				06/19/2018	2019.01	06/19/2018 01:45:20 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	809	0	2019	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	810	0	2	01	01	H5854_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:45:41 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		2	1		H5854	810	0	2019	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	811	0	2	01	01	H5854_811_0	2	1				06/19/2018	2019.01	06/19/2018 01:45:57 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	01	01		2	1		H5854	811	0	2019	Select CT counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5859	001	0	1	02	01	H5859_001_0	6	1	2	1		06/29/2018	2019.01	06/29/2018 01:22:33 PM Pacific Daylight Time	08/06/2018 08:48:56 AM Pacific Daylight Time	08/06/2018 08:48:56 AM Pacific Daylight Time			08/07/2018 12:02:58 PM Pacific Daylight Time	HEALTH PLAN OF CAREOREGON, INC.	CareOregon Advantage	www.careoregonadvantage.org	CareOregon Advantage Plus (HMO-POS SNP)	01	02		1			H5859	001	0	2019	Portland Metro Area, Jackson, Tillamook, Columbia		2		2			1	3		2		2	http://www.careoregonadvantage.org/member-resources/find-a-provider	http://www.careoregonadvantage.org/member-resources/rx-and-drug-information/are-my-drugs-covered-	http://www.careoregonadvantage.org/member-resources/find-a-provider	(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H5883	001	1	1	02	01	H5883_001_1	6	1			2	06/29/2018	2019.01	06/29/2018 05:13:36 PM Eastern Daylight Time	07/20/2018 01:56:54 PM Eastern Daylight Time				07/20/2018 06:02:15 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	1	2019	Michigan	Region 1	2	4154	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	2	1	02	01	H5883_001_2	5	1			2	05/31/2018	2019.01	05/31/2018 04:52:48 PM Eastern Daylight Time	07/20/2018 01:57:40 PM Eastern Daylight Time				07/20/2018 06:02:15 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	2	2019	Michigan	Region 2	2	1740	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	3	1	02	01	H5883_001_3	5	1			2	05/31/2018	2019.01	05/31/2018 04:52:54 PM Eastern Daylight Time	07/20/2018 01:58:27 PM Eastern Daylight Time				07/20/2018 06:02:15 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	3	2019	Michigan	Region 3	2	847	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	4	1	02	01	H5883_001_4	5	1			2	05/31/2018	2019.01	05/31/2018 04:53:03 PM Eastern Daylight Time	07/20/2018 01:59:15 PM Eastern Daylight Time				07/20/2018 06:02:15 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	4	2019	Michigan	Region 4	2	2629	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	5	1	02	01	H5883_001_5	6	1			2	06/29/2018	2019.01	06/29/2018 05:13:11 PM Eastern Daylight Time	07/20/2018 02:00:03 PM Eastern Daylight Time				07/20/2018 06:02:15 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	5	2019	Michigan	Region 5	2	3758	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	002	1	1	02	01	H5883_002_1	7	1			2	06/29/2018	2019.01	06/29/2018 05:12:18 PM Eastern Daylight Time	08/03/2018 03:46:41 PM Eastern Daylight Time	08/01/2018 10:57:07 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	1	2019	Michigan	Region 1	2	55081	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	2	1	02	01	H5883_002_2	6	1			2	06/04/2018	2019.01	06/04/2018 01:03:23 PM Eastern Daylight Time	08/03/2018 03:47:35 PM Eastern Daylight Time	08/01/2018 10:57:36 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	2	2019	Michigan	Region 2	2	31106	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	3	1	02	01	H5883_002_3	6	1			2	06/04/2018	2019.01	06/04/2018 01:04:01 PM Eastern Daylight Time	08/03/2018 03:48:34 PM Eastern Daylight Time	08/01/2018 10:58:05 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	3	2019	Michigan	Region 3	2	16446	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	4	1	02	01	H5883_002_4	6	1			2	06/04/2018	2019.01	06/04/2018 01:04:32 PM Eastern Daylight Time	08/03/2018 03:49:32 PM Eastern Daylight Time	08/01/2018 10:58:34 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	4	2019	Michigan	Region 4	2	45581	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	7	1	02	01	H5883_002_7	7	1			2	06/29/2018	2019.01	06/29/2018 05:11:43 PM Eastern Daylight Time	08/03/2018 03:50:28 PM Eastern Daylight Time	08/01/2018 10:59:03 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	7	2019	Michigan	Region 5	2	82977	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	1	1	02	01	H5883_003_1	8	1			1	06/29/2018	2019.01	06/29/2018 05:11:18 PM Eastern Daylight Time	08/03/2018 03:51:24 PM Eastern Daylight Time	08/01/2018 10:59:31 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	1	2019	Michigan	Region 1	2	3301	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	2	1	02	01	H5883_003_2	7	1			1	06/27/2018	2019.01	06/27/2018 02:59:16 PM Eastern Daylight Time	08/03/2018 03:52:20 PM Eastern Daylight Time	08/01/2018 11:00:01 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	2	2019	Michigan	Region 2	2	2325	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	3	1	02	01	H5883_003_3	7	1			1	06/27/2018	2019.01	06/27/2018 03:05:18 PM Eastern Daylight Time	08/03/2018 03:53:17 PM Eastern Daylight Time	08/01/2018 11:00:30 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	3	2019	Michigan	Region 3	2	851	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	4	1	02	01	H5883_003_4	7	1			1	06/27/2018	2019.01	06/27/2018 03:05:04 PM Eastern Daylight Time	08/03/2018 03:54:14 PM Eastern Daylight Time	08/01/2018 11:01:00 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	4	2019	Michigan	Region 4	2	3573	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	5	1	02	01	H5883_003_5	8	1			1	06/29/2018	2019.01	06/29/2018 05:10:46 PM Eastern Daylight Time	08/03/2018 03:55:10 PM Eastern Daylight Time	08/01/2018 11:01:29 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	5	2019	Michigan	Region 5	2	12337	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	1	1	02	01	H5883_004_1	7	1			2	08/06/2018	2019.01	08/06/2018 11:09:30 AM Eastern Daylight Time	08/03/2018 03:56:06 PM Eastern Daylight Time	08/01/2018 11:01:59 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	1	2019	Michigan	Region 1	2	46252	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	2	1	02	01	H5883_004_2	5	1			2	08/06/2018	2019.01	08/06/2018 11:10:53 AM Eastern Daylight Time	08/03/2018 03:57:02 PM Eastern Daylight Time	08/01/2018 11:02:28 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	2	2019	Michigan	Region 2	2	44825	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	3	1	02	01	H5883_004_3	6	1			2	08/06/2018	2019.01	08/06/2018 11:11:05 AM Eastern Daylight Time	08/03/2018 03:57:58 PM Eastern Daylight Time	08/01/2018 11:02:57 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	3	2019	Michigan	Region 3	2	33888	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	4	1	02	01	H5883_004_4	6	1			2	08/06/2018	2019.01	08/06/2018 11:11:18 AM Eastern Daylight Time	08/03/2018 03:58:54 PM Eastern Daylight Time	08/01/2018 11:03:26 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	4	2019	Michigan	Region 4	2	60966	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	5	1	02	01	H5883_004_5	7	1			2	08/06/2018	2019.01	08/06/2018 11:11:29 AM Eastern Daylight Time	08/03/2018 03:59:50 PM Eastern Daylight Time	08/01/2018 11:03:55 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	5	2019	Michigan	Region 5	2	128471	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	007	0	1	01	01	H5883_007_0	6	1			2	06/04/2018	2019.01	06/04/2018 12:08:13 PM Eastern Daylight Time	08/03/2018 04:00:46 PM Eastern Daylight Time	08/01/2018 11:11:28 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO ConnectedCare (HMO)	01	01		1			H5883	007	0	2019	Gen,Kzoo,Liv,Mac,Oak,StClair,Wash,Wyn,Sag,Ios,Are		2	58458	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	008	1	1	01	01	H5883_008_1	6	1			2	06/04/2018	2019.01	06/04/2018 12:08:47 PM Eastern Daylight Time	08/03/2018 04:01:42 PM Eastern Daylight Time	08/01/2018 11:11:58 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO MyChoice Wellness (HMO)	01	01		1			H5883	008	1	2019	West Michigan	Region 1	2	36505	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	008	2	1	01	01	H5883_008_2	6	1			2	06/04/2018	2019.01	06/04/2018 12:12:04 PM Eastern Daylight Time	08/03/2018 04:02:36 PM Eastern Daylight Time	08/01/2018 11:12:27 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO MyChoice Wellness (HMO)	01	01		1			H5883	008	2	2019	West Michigan	Region 2	2	15950	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	009	1	1	01	01	H5883_009_1	6	1			2	06/01/2018	2019.01	06/01/2018 01:27:53 PM Eastern Daylight Time	08/03/2018 04:03:32 PM Eastern Daylight Time	08/01/2018 11:12:56 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthySaver (HMO)	01	01		1			H5883	009	1	2019	Grand Rapids and Detroit Metro areas	Region 1	2	11608	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	009	2	1	01	01	H5883_009_2	6	1			2	06/01/2018	2019.01	06/01/2018 01:30:39 PM Eastern Daylight Time	08/03/2018 04:04:27 PM Eastern Daylight Time	08/01/2018 11:13:25 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthySaver (HMO)	01	01		1			H5883	009	2	2019	Grand Rapids and Detroit Metro areas	Region 2	2	4425	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	009	3	1	01	01	H5883_009_3	6	1			2	06/01/2018	2019.01	06/01/2018 01:30:39 PM Eastern Daylight Time	08/03/2018 04:05:22 PM Eastern Daylight Time	08/01/2018 11:13:55 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthySaver (HMO)	01	01		1			H5883	009	3	2019	Grand Rapids and Detroit Metro areas	Region 3	2	32159	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	011	1	1	01	01	H5883_011_1	6	1			2	08/06/2018	2019.01	08/06/2018 11:12:02 AM Eastern Daylight Time	08/03/2018 04:06:16 PM Eastern Daylight Time	08/01/2018 11:14:25 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthyValue (HMO)	01	01		1			H5883	011	1	2019	Grand Rapids and Detroit Metro areas	Region 1	2	5118	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	011	2	1	01	01	H5883_011_2	6	1			2	08/06/2018	2019.01	08/06/2018 11:12:13 AM Eastern Daylight Time	08/03/2018 04:07:12 PM Eastern Daylight Time	08/01/2018 11:14:55 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthyValue (HMO)	01	01		1			H5883	011	2	2019	Grand Rapids and Detroit Metro areas	Region 2	2	1951	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	011	3	1	01	01	H5883_011_3	6	1			2	08/06/2018	2019.01	08/06/2018 11:12:23 AM Eastern Daylight Time	08/03/2018 04:08:06 PM Eastern Daylight Time	08/01/2018 11:15:25 AM Eastern Daylight Time			08/06/2018 06:19:47 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthyValue (HMO)	01	01		1			H5883	011	3	2019	Grand Rapids and Detroit Metro areas	Region 3	2	14180	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	801	0	1	02	01	H5883_801_0	4	1				06/03/2018	2019.01	06/03/2018 01:28:15 PM Eastern Daylight Time					06/04/2018 08:51:13 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage (HMO-POS)	01	02		1			H5883	801	0	2019	Employer Group		1	294739	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;17a;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;14a;14d;15;16b;18a;	2		1				
H5883	805	0	1	02	01	H5883_805_0	4	1				06/03/2018	2019.01	06/03/2018 01:28:51 PM Eastern Daylight Time					06/04/2018 08:51:13 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage (HMO-POS)	01	02		1			H5883	805	0	2019	Employer Group		1	91591	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;17a;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;14a;14d;15;16b;18a;	2		1				
H5902	001	0	1	20	08	H5902_001_0	1	1				05/25/2018	2019.01	05/25/2018 10:04:35 AM Eastern Daylight Time		05/25/2018 09:43:43 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Ebensburg	www.seniorlifepa.com	Senior LIFE Altoona Dual Eligible (PACE)	08	20		1			H5902	001	0	2019	Senior LIFE Blair Indiana Cambria County Dual		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5902	002	0	1	20	08	H5902_002_0	1	1				05/25/2018	2019.01	05/25/2018 10:04:45 AM Eastern Daylight Time		05/25/2018 09:43:43 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Ebensburg	www.seniorlifepa.com	Senior LIFE Altoona Medicare Only (PACE)	08	20		1			H5902	002	0	2019	Senior LIFE Balir Indiana Cambria County MC Only		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5926	001	0	1	01	01	H5926_001_0	5	1	2	1		07/12/2018	2019.01	07/12/2018 01:41:36 PM Pacific Daylight Time	08/04/2018 10:27:22 AM Pacific Daylight Time	08/04/2018 11:20:08 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5926	001	0	2019	Grand Rapids, Flint, Saginaw, Detroit		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-3072		(800)665-3072		(866)403-8293		(866)403-8293		(800)665-3072		(800)665-3072		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	001	0	1	01	01	H5928_001_0	2	1	2	1		08/03/2018	2019.01	08/03/2018 12:39:15 PM Pacific Daylight Time	08/02/2018 01:46:23 PM Pacific Daylight Time	07/31/2018 01:36:20 PM Pacific Daylight Time			08/03/2018 03:05:32 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise TotalDual Plan (HMO SNP)	01	01		1			H5928	001	0	2019	Los Angeles County		2	4064	2			1	3		2		1	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	004	0	1	01	01	H5928_004_0	3	1				06/01/2018	2019.01	06/01/2018 10:21:27 AM Pacific Daylight Time	08/02/2018 01:48:56 PM Pacific Daylight Time	07/31/2018 01:37:57 PM Pacific Daylight Time			08/03/2018 03:05:32 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	01	01		1			H5928	004	0	2019	Los Angeles and Orange Counties		2	266338	2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	005	0	1	01	01	H5928_005_0	2	1	2	1		08/03/2018	2019.01	08/03/2018 12:39:33 PM Pacific Daylight Time	08/02/2018 01:52:21 PM Pacific Daylight Time	07/31/2018 01:39:04 PM Pacific Daylight Time			08/03/2018 03:10:41 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise TotalDual Plan (HMO SNP)	01	01		1			H5928	005	0	2019	Orange and San Bernardino Counties		2	2079	2			1	3		2		1	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	009	0	1	01	01	H5928_009_0	2	1	2	1		08/03/2018	2019.01	08/03/2018 12:39:53 PM Pacific Daylight Time	08/02/2018 01:53:49 PM Pacific Daylight Time	07/31/2018 01:40:00 PM Pacific Daylight Time			08/03/2018 03:10:41 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise TotalDual Plan (HMO SNP)	01	01		1			H5928	009	0	2019	San Diego County		2	2555	2			1	3		2		1	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	010	0	1	01	01	H5928_010_0	4	1				05/29/2018	2019.01	05/29/2018 05:21:32 PM Pacific Daylight Time	08/02/2018 01:55:27 PM Pacific Daylight Time	07/31/2018 01:41:06 PM Pacific Daylight Time			08/03/2018 03:18:48 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	01	01		1			H5928	010	0	2019	San Diego County		2	130714	2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	016	0	1	01	01	H5928_016_0	2	1				05/29/2018	2019.01	05/29/2018 05:27:20 PM Pacific Daylight Time	08/02/2018 01:56:53 PM Pacific Daylight Time	07/31/2018 01:42:04 PM Pacific Daylight Time			08/03/2018 03:18:48 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	01	01		1			H5928	016	0	2019	Santa Clara County		2	28081	2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	037	0	1	01	01	H5928_037_0	3	1				08/03/2018	2019.01	08/03/2018 12:40:41 PM Pacific Daylight Time	08/02/2018 01:58:45 PM Pacific Daylight Time	07/31/2018 01:43:08 PM Pacific Daylight Time			08/03/2018 03:20:37 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise Coordinated Choice Plan (HMO)	01	01		1			H5928	037	0	2019	Counties: LA, OR, SD, SB, RV, SC, FR, ME, SJ, ST		2	382144	2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	044	0	1	01	01	H5928_044_0	2	1				05/29/2018	2019.01	05/29/2018 05:20:07 PM Pacific Daylight Time	08/03/2018 06:04:46 AM Pacific Daylight Time	07/31/2018 01:44:14 PM Pacific Daylight Time			08/03/2018 03:20:37 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	01	01		1			H5928	044	0	2019	Fresno County		2	18220	2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5932	001	0	1	01	01	H5932_001_0	12	1	2	1		08/07/2018	2019.01	08/07/2018 08:05:15 AM Eastern Daylight Time	08/07/2018 08:01:31 AM Eastern Daylight Time	08/07/2018 08:01:32 AM Eastern Daylight Time			08/07/2018 08:19:20 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H5932	001	0	2019	Pennsylvania Counties		2	517918	2			1	3		1		1	www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5932	009	0	1	01	01	H5932_009_0	12	1	2	1		08/07/2018	2019.01	08/07/2018 07:02:35 AM Eastern Daylight Time	08/07/2018 08:01:34 AM Eastern Daylight Time	08/07/2018 08:01:35 AM Eastern Daylight Time			08/07/2018 08:19:20 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H5932	009	0	2019	Pennsylvania Counties		2	78938	2			1	3		2		2	www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5934	001	0	1	20	08	H5934_001_0	1	1				05/23/2018	2019.01	05/23/2018 10:35:25 AM Eastern Daylight Time		05/23/2018 09:28:58 AM Eastern Daylight Time			05/23/2018 10:37:42 AM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	www.hopepace.org	Hope PACE (PACE)	08	20		1			H5934	001	0	2019	Lee, Charlotte and Collier Counties Florida		2		2			2						carekinesis.com	hopehcs.org/pace										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400																
H5934	002	0	1	20	08	H5934_002_0	1	1				05/23/2018	2019.01	05/23/2018 10:35:47 AM Eastern Daylight Time		05/23/2018 09:29:56 AM Eastern Daylight Time			05/23/2018 10:37:42 AM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	www.hopepace.org	Hope PACE (PACE)	08	20		1			H5934	002	0	2019	Lee, Charlotte and Collier Counties Florida		2		2			2						carekinesis.com	hopehcs.org/pace										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400																
H5937	001	0	1	01	01	H5937_001_0	4	1	2	1		08/07/2018	2019.01	08/07/2018 04:27:59 PM Central Daylight Time	08/07/2018 03:50:37 PM Central Daylight Time	08/02/2018 04:18:07 PM Central Daylight Time			08/07/2018 04:32:48 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Connect + Medicare (HMO SNP)	01	01		1			H5937	001	0	2019	Twin Cities Metro Area, Rochester, St. Cloud		2		2			1	3		1		1	www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(855)260-9707		(612)676-3310		(855)432-7028		(612)676-3554		(855)260-9707		(612)676-3310		(855)432-7028		(612)676-3554		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H5938	001	0	1	01	01	H5938_001_0	6	1				07/17/2018	2019.01	07/17/2018 02:53:10 PM Eastern Daylight Time	08/06/2018 06:00:45 PM Eastern Daylight Time	08/06/2018 06:01:04 PM Eastern Daylight Time			08/07/2018 09:31:36 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Advantage Plus (HMO)	01	01		1			H5938	001	0	2019	Leon and surrounding counties		2	115200	2			2						www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		2					2					2	2			
H5938	006	0	1	01	01	H5938_006_0	5	1				05/24/2018	2019.01	05/24/2018 08:35:01 AM Eastern Daylight Time	08/06/2018 06:01:33 PM Eastern Daylight Time	08/06/2018 06:02:04 PM Eastern Daylight Time			08/07/2018 09:31:36 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Preferred Advantage (HMO)	01	01		1			H5938	006	0	2019	Leon and surrounding counties		2	32004	2			2						www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		2					2					2	2			
H5938	802	0	1	01	01	H5938_802_0	3	1				05/22/2018	2019.01	05/22/2018 02:49:13 PM Eastern Daylight Time					06/04/2018 06:39:40 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	802	0	2019	Leon and surrounding counties		1	102557	2			2						www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7i;8a;8b1;8b2;9a1;9b;9c;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;14a;14d;14e2;14e3;14e4;14e5;14e6;16b;	1					1				
H5938	803	0	1	01	01	H5938_803_0	3	1				05/10/2018	2019.01	05/10/2018 12:06:42 PM Eastern Daylight Time					06/04/2018 06:39:40 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	803	0	2019	Leon and surrounding counties		1	12340	2			2						www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441										(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534										1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7i;8a;8b1;8b2;9a1;9b;9c;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;14a;14d;14e2;14e3;14e4;14e5;14e6;16b;	1					1				
H5938	804	0	1	01	01	H5938_804_0	3	1				05/10/2018	2019.01	05/10/2018 12:16:41 PM Eastern Daylight Time					06/04/2018 06:39:40 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	804	0	2019	Leon and surrounding counties		1	20846	2			2						www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7i;8a;8b1;8b2;9a1;9b;9c;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;14a;14d;14e2;14e3;14e4;14e5;14e6;16b;	1					1				
H5943	001	0	1	02	01	H5943_001_0	4	1		1		08/01/2018	2019.01	08/01/2018 04:06:59 PM Pacific Daylight Time		08/01/2018 09:51:17 AM Pacific Daylight Time		08/01/2018 03:04:16 PM Pacific Daylight Time	08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS SNP)	01	02		1			H5943	001	0	2019	Riverside and  San Bernardino Counties		2		2			1	4			00000000100000000000		www.villagehealthca.com	www.villagehealthca.com	www.villagehealthca.com	(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5943	002	0	1	02	01	H5943_002_0	4	1		1		08/01/2018	2019.01	08/01/2018 04:09:40 PM Pacific Daylight Time		08/01/2018 09:52:10 AM Pacific Daylight Time		08/01/2018 03:06:02 PM Pacific Daylight Time	08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS SNP)	01	02		1			H5943	002	0	2019	Los Angeles and Orange Counties		2		2			1	4			00000000100000000000		www.villagehealthca.com	www.villagehealthca.com	www.villagehealthca.com	(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	001	0	1	01	01	H5945_001_0	9	1				08/03/2018	2019.01	08/03/2018 06:34:30 PM Pacific Daylight Time	08/06/2018 04:25:46 PM Pacific Daylight Time	08/06/2018 04:25:46 PM Pacific Daylight Time			08/06/2018 04:27:18 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	001	0	2019	Northern Nevada		2	14500	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	002	0	1	01	01	H5945_002_0	9	1				08/03/2018	2019.01	08/03/2018 01:22:44 PM Pacific Daylight Time	08/06/2018 04:25:46 PM Pacific Daylight Time	08/06/2018 04:25:47 PM Pacific Daylight Time			08/06/2018 04:29:19 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	002	0	2019	Washoe County		2	8000	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	801	0	1	01	01	H5945_801_0	2	1				05/22/2018	2019.01	05/22/2018 02:04:00 PM Pacific Daylight Time					06/04/2018 10:54:03 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	801	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5945	802	0	1	01	01	H5945_802_0	2	1				05/22/2018	2019.01	05/22/2018 02:20:56 PM Pacific Daylight Time					06/04/2018 10:55:43 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	802	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	803	0	1	01	01	H5945_803_0	2	1				05/22/2018	2019.01	05/22/2018 02:39:26 PM Pacific Daylight Time					06/04/2018 10:56:54 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	803	0	2019	National		1	0	1	1		2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5959	007	1	1	04	01	H5959_007_1	9	1				07/26/2018	2019.01	07/26/2018 12:43:48 PM Central Daylight Time	05/31/2018 06:13:46 PM Central Daylight Time				07/26/2018 03:39:47 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice MA Only (PPO)	01	04		1			H5959	007	1	2019	50 County Region	Nine County Region	2	53199	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5959	007	2	1	04	01	H5959_007_2	8	1				07/26/2018	2019.01	07/26/2018 12:45:06 PM Central Daylight Time	05/31/2018 06:14:50 PM Central Daylight Time				07/26/2018 03:39:47 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice MA Only (PPO)	01	04		1			H5959	007	2	2019	50 County Region	41 County Region	2	45745	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5959	008	0	1	04	01	H5959_008_0	9	1				07/26/2018	2019.01	07/26/2018 12:47:01 PM Central Daylight Time	05/31/2018 06:15:50 PM Central Daylight Time				07/26/2018 03:39:47 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice MA Only (PPO)	01	04		1			H5959	008	0	2019	16 County Region		2	20594	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5959	009	0	1	04	01	H5959_009_0	8	1				07/26/2018	2019.01	07/26/2018 12:48:17 PM Central Daylight Time	08/01/2018 10:57:00 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	01	04		1			H5959	009	0	2019	16 County Region		2	124850	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	010	1	1	04	01	H5959_010_1	7	1				07/26/2018	2019.01	07/26/2018 12:49:50 PM Central Daylight Time	08/01/2018 10:58:00 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	01	04		1			H5959	010	1	2019	50 County Region	Nine County Region	2	266330	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513				(800)711-9865		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	010	2	1	04	01	H5959_010_2	7	1				07/26/2018	2019.01	07/26/2018 12:51:10 PM Central Daylight Time	08/01/2018 10:59:04 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	01	04		1			H5959	010	2	2019	50 County Region	41 County Region	2	230749	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513				(800)711-9865		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	011	0	1	04	01	H5959_011_0	7	1				07/26/2018	2019.01	07/26/2018 02:14:42 PM Central Daylight Time	08/01/2018 11:00:04 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	01	04		1			H5959	011	0	2019	16 County Region		2	115792	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513				(800)711-9865		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	012	0	1	04	01	H5959_012_0	7	1				07/26/2018	2019.01	07/26/2018 02:16:46 PM Central Daylight Time	08/01/2018 11:01:06 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	01	04		1			H5959	012	0	2019	16 County Region		2	18773	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	013	1	1	04	01	H5959_013_1	7	1				07/26/2018	2019.01	07/26/2018 02:18:41 PM Central Daylight Time	08/01/2018 11:02:06 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	01	04		1			H5959	013	1	2019	50 County Region	Nine County Region	2	53921	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	013	2	1	04	01	H5959_013_2	7	1				07/26/2018	2019.01	07/26/2018 02:19:50 PM Central Daylight Time	08/01/2018 11:03:08 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	01	04		1			H5959	013	2	2019	50 County Region	41 County Region	2	37324	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	014	1	1	04	01	H5959_014_1	7	1				07/26/2018	2019.01	07/26/2018 02:21:00 PM Central Daylight Time	08/01/2018 11:04:08 AM Central Daylight Time	08/02/2018 01:55:30 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	01	04		1			H5959	014	1	2019	50 County Region	Nine County Region	2	345056	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	014	2	1	04	01	H5959_014_2	7	1				07/26/2018	2019.01	07/26/2018 02:22:03 PM Central Daylight Time	08/01/2018 11:05:14 AM Central Daylight Time	08/02/2018 01:55:32 PM Central Daylight Time			08/03/2018 03:04:59 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	01	04		1			H5959	014	2	2019	50 County Region	41 County Region	2	271852	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	801	0	1	04	01	H5959_801_0	3	1				05/31/2018	2019.01	05/31/2018 08:37:39 PM Central Daylight Time					05/31/2018 08:45:00 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Group EGWP MAPD (PPO)	01	04		1			H5959	801	0	2019	66 County region		1	455	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com			(800)711-9865		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;12;15;16b;	2		1									
H5959	807	0	1	04	01	H5959_807_0	1	1				06/01/2018	2019.01	06/01/2018 10:30:41 AM Central Daylight Time					06/01/2018 10:43:19 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Group EGWP Medical Only (PPO)	01	04		1			H5959	807	0	2019	66 County Region		1	455	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com			(800)711-9865		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;12;15;16b;	2		1									
H5969	002	0	1	01	01	H5969_002_0	4	1	2	1		07/02/2018	2019.01	07/02/2018 12:39:50 PM Pacific Daylight Time	07/31/2018 01:16:19 PM Pacific Daylight Time	07/31/2018 01:17:42 PM Pacific Daylight Time			08/01/2018 02:49:26 PM Pacific Daylight Time	ALOHACARE	AlohaCare	AlohaCare.org	AlohaCare Advantage Plus (HMO SNP)	01	01		1			H5969	002	0	2019	State of Hawaii		2	33515	2			1	3		2		2	AlohaCare.org	AlohaCare.org	AlohaCare.org	(866)973-6395		(808)973-6395		(866)973-6395		(808)973-6395		(866)973-6395		(808)973-6395		(866)973-6395		(808)973-6395		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		2					2					2	2			
H5970	001	0	1	04	01	H5970_001_0	5	1				07/18/2018	2019.01	07/18/2018 03:48:55 PM Eastern Daylight Time	06/01/2018 03:17:26 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-001 (PPO)	01	04		1			H5970	001	0	2019	Southern Tier Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	015	0	1	04	01	H5970_015_0	5	1				07/18/2018	2019.01	07/18/2018 03:47:35 PM Eastern Daylight Time	06/01/2018 03:20:02 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-015 (PPO)	01	04		1			H5970	015	0	2019	Select Counties in New York		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	016	0	1	04	01	H5970_016_0	2	1				07/02/2018	2019.01	07/02/2018 12:07:26 PM Eastern Daylight Time	06/01/2018 03:15:29 PM Eastern Daylight Time				07/06/2018 02:51:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-016 (PPO)	01	04		1			H5970	016	0	2019	Select Counties in New York		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5970	018	0	1	04	01	H5970_018_0	3	1				07/02/2018	2019.01	07/02/2018 12:07:45 PM Eastern Daylight Time	06/01/2018 03:15:59 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:03:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-018 (PPO)	01	04		1			H5970	018	0	2019	Select Counties in New York		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	019	0	1	04	01	H5970_019_0	5	1				07/18/2018	2019.01	07/18/2018 03:49:53 PM Eastern Daylight Time	08/03/2018 05:21:52 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-019 (PPO)	01	04		1			H5970	019	0	2019	Select Counties in New York		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	020	0	1	04	01	H5970_020_0	4	1	2	1		07/11/2018	2019.01	07/11/2018 04:19:35 PM Eastern Daylight Time	06/01/2018 03:25:33 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5970-020 (PPO SNP)	01	04		1			H5970	020	0	2019	Cattaraugus, Chautauqua and Madison counties		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	021	0	1	04	01	H5970_021_0	5	1				07/18/2018	2019.01	07/18/2018 03:50:48 PM Eastern Daylight Time	08/03/2018 05:22:54 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-021 (PPO)	01	04		1			H5970	021	0	2019	Select Counties in New York City and Long Island		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	022	0	1	04	01	H5970_022_0	5	1				07/18/2018	2019.01	07/18/2018 03:51:40 PM Eastern Daylight Time	06/01/2018 03:21:07 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-022 (PPO)	01	04		1			H5970	022	0	2019	Select Counties in New York City and Long Island		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	023	0	1	04	01	H5970_023_0	4	1				07/11/2018	2019.01	07/11/2018 12:23:33 PM Eastern Daylight Time	06/01/2018 03:21:44 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:06:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-023 (PPO)	01	04		1			H5970	023	0	2019	Select Counties in New York City and Long Island		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	801	0	1	04	01	H5970_801_0	1	1				05/31/2018	2019.01	05/31/2018 11:51:30 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	801	0	2019	State of New York		1	27565	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	802	0	1	04	01	H5970_802_0	1	1				05/31/2018	2019.01	05/31/2018 11:53:09 AM Eastern Daylight Time					05/31/2018 01:12:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	802	0	2019	State of New York		1	6680	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	803	0	1	04	01	H5970_803_0	1	1				05/31/2018	2019.01	05/31/2018 11:54:30 AM Eastern Daylight Time					05/31/2018 01:20:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5970	803	0	2019	State of New York		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	805	0	2	04	01	H5970_805_0	1	1				05/31/2018	2019.01	05/31/2018 11:55:03 AM Eastern Daylight Time					05/31/2018 01:20:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5970	805	0	2019	State of New York		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	806	0	2	04	01	H5970_806_0	1	1				05/31/2018	2019.01	05/31/2018 11:55:28 AM Eastern Daylight Time					05/31/2018 01:20:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5970	806	0	2019	State of New York		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	807	0	2	04	01	H5970_807_0	1	1				05/31/2018	2019.01	05/31/2018 11:56:13 AM Eastern Daylight Time					05/31/2018 01:20:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5970	807	0	2019	State of New York		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5978	001	0	1	20	08	H5978_001_0	1	1				05/25/2018	2019.01	05/25/2018 10:05:00 AM Eastern Daylight Time		05/25/2018 09:43:53 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	Senior LIFE Lehigh Valley, Inc.	www.seniorlifepa.com	Senior LIFE Lehigh Valley Dual Eligible (PACE)	08	20		1			H5978	001	0	2019	Senior LIFE Northampton Lehigh County Dual		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5978	002	0	1	20	08	H5978_002_0	1	1				05/25/2018	2019.01	05/25/2018 10:05:11 AM Eastern Daylight Time		05/25/2018 09:43:51 AM Eastern Daylight Time			05/25/2018 10:09:16 AM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	Senior LIFE Lehigh Valley, Inc.	www.everydaylifecenters.org	Senior LIFE Lehigh Valley MC Only (PACE)	08	20		1			H5978	002	0	2019	Senior LIFE Lehigh and Northampton County MC Only		2		2			2						http://granerx.com/	NA										(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5989	002	0	1	01	01	H5989_002_0	4	1		1		08/06/2018	2019.01	08/06/2018 12:59:46 PM Central Daylight Time	08/06/2018 12:39:41 PM Central Daylight Time	08/06/2018 12:37:16 PM Central Daylight Time			08/07/2018 04:43:31 PM Central Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare	www.centerlighthealthcare.org	CenterLight Healthcare Direct Complete Plan (HMO SNP)	01	01		1			H5989	002	0	2019	NYC, LI, Westchester and Rockland Counties		2	7752	2			1	1	3				www.centerlighthealthcare.org	www.centerlighthealthcare.org	www.centerlighthealthcare.org	(833)252-2737		(347)640-6000		(833)252-2737		(347)640-6000		(833)252-2737		(833)252-2737		(833)252-2737		(347)640-6280		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5991	001	0	1	01	01	H5991_001_0	9	1	2	1		08/03/2018	2019.01	08/03/2018 01:48:31 PM Eastern Daylight Time	08/02/2018 09:50:16 AM Eastern Daylight Time	08/02/2018 02:13:54 PM Eastern Daylight Time			08/06/2018 12:58:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Ultimate (HMO SNP)	01	01		1			H5991	001	0	2019	NYC, Nassau ,Orange, Rockland, Suffolk,Westchester		2	86524	2			1	3		1		1	www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)362-4002		(877)234-4499		(877)234-4499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5991	002	0	1	01	01	H5991_002_0	7	1	2	1		08/10/2018	2019.01	08/10/2018 08:48:12 AM Eastern Daylight Time	08/02/2018 09:52:24 AM Eastern Daylight Time	08/02/2018 02:16:36 PM Eastern Daylight Time			08/10/2018 09:48:04 AM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Solutions (HMO SNP)	01	01		1			H5991	002	0	2019	NYC, Nassau ,Orange, Rockland, Suffolk,Westchester		2	22528	2			1	3		2		2	www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)362-4002		(877)234-4499		(877)234-4499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5991	003	0	1	01	01	H5991_003_0	6	1				07/24/2018	2019.01	07/24/2018 09:41:48 AM Eastern Daylight Time	08/02/2018 09:54:32 AM Eastern Daylight Time	08/02/2018 02:17:22 PM Eastern Daylight Time			08/06/2018 12:58:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Essentials (HMO)	01	01		1			H5991	003	0	2019	Nassau,Orange, Rockland, Westchester		2	43970	2			2						www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)362-4002		(877)234-4499		(877)234-4499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5991	006	0	1	01	01	H5991_006_0	6	1				07/23/2018	2019.01	07/23/2018 05:06:01 PM Eastern Daylight Time	08/02/2018 09:56:34 AM Eastern Daylight Time	08/02/2018 02:18:00 PM Eastern Daylight Time			08/06/2018 12:58:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Essentials NYC (HMO)	01	01		1			H5991	006	0	2019	NY, Bronx, Queens, Kings, Richmond		2	29955	2			2						www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)362-4002		(877)234-4499		(877)234-4499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5992	007	0	1	01	01	H5992_007_0	5	1	2	1		08/02/2018	2019.01	08/02/2018 07:23:36 PM Eastern Daylight Time	08/06/2018 11:08:50 PM Eastern Daylight Time	08/06/2018 11:08:58 PM Eastern Daylight Time			08/06/2018 11:13:58 PM Eastern Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.seniorwholehealth.com	Senior Whole Health of New York NHC (HMO SNP)	01	01		1			H5992	007	0	2019	Counties: Ki, Qu, Brx, NY, Wes, and Na		2	2288	2			1	3		2		1	www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(877)353-0185		(877)353-0185		(877)353-0188		(877)353-0188		(877)353-0185		(877)353-0185		(877)353-0188		(877)353-0188		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5995	001	0	1	01	01	H5995_001_0	12	1	2	1		08/02/2018	2019.01	08/02/2018 09:10:42 AM Pacific Daylight Time	08/02/2018 08:52:08 AM Pacific Daylight Time	08/01/2018 12:22:59 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Special Needs Plan (Willamette) (HMO SNP)	01	01		1			H5995	001	0	2019	Marion and Polk Counties		2	39900	2			1	3		2		2	atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2	2			
H6059	001	0	1	20	08	H6059_001_0	1	1				05/25/2018	2019.01	05/25/2018 04:12:40 PM Eastern Daylight Time		05/25/2018 03:06:47 PM Eastern Daylight Time			05/25/2018 04:15:24 PM Eastern Daylight Time	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Dual (PACE)	08	20		1			H6059	001	0	2019	PACE of The Triad - Dual		2		2			2						www.pacetriad.org	www.pacetriad.org										(336)550-4040		(336)550-4040		(336)550-4040		(336)550-4040										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6059	002	0	1	20	08	H6059_002_0	1	1				05/25/2018	2019.01	05/25/2018 04:13:17 PM Eastern Daylight Time		05/25/2018 03:06:48 PM Eastern Daylight Time			05/25/2018 04:15:24 PM Eastern Daylight Time	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Medicare only (PACE)	08	20		1			H6059	002	0	2019	PACE of The Triad - Medicare only		2		2			2						www.pacetriad.org	www.pacetriad.org										(336)550-4040		(336)550-4040		(336)550-4040		(336)550-4040										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6079	001	0	1	20	08	H6079_001_0	1	1				05/23/2018	2019.01	05/23/2018 02:21:17 PM Mountain Daylight Time		05/23/2018 02:05:13 PM Mountain Daylight Time			05/23/2018 02:26:27 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	08	20		1			H6079	001	0	2019	San Bernardino and Riverside counties		2		2			2						www.pharmerica.com	www.totallongtermcare.org										(877)653-0015		(909)890-2800		(877)653-0015		(909)890-2800										(877)653-0015		(877)653-0015		(877)653-0015		(877)653-0015																
H6079	002	0	1	20	08	H6079_002_0	1	1				05/23/2018	2019.01	05/23/2018 02:21:31 PM Mountain Daylight Time		05/23/2018 02:05:28 PM Mountain Daylight Time			05/23/2018 02:26:27 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	08	20		1			H6079	002	0	2019	San Bernardino and Riverside counties		2		2			2						www.pharmerica.com	www.totallongtermcare.org										(877)653-0015		(909)890-2800		(877)653-0015		(909)890-2800										(877)653-0015		(877)653-0015		(877)653-0015		(877)653-0015																
H6080	001	0	1	48	05	H6080_001_0	4	1				08/22/2018	2019.01	08/22/2018 01:12:34 PM Eastern Daylight Time					08/22/2018 01:12:43 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	MeridianComplete	www.mhplan.com	MeridianComplete (Medicare-Medicaid Plan)	05	48		1			H6080	001	0	2019	Greater Chicago		2	82008	2			2						www.mhplan.com	www.mhplan.com	www.mhplan.com	(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6154	001	0	1	02	01	H6154_001_0	9	1				05/31/2018	2019.01	05/31/2018 04:34:29 PM Central Daylight Time	08/02/2018 09:41:44 AM Central Daylight Time	08/01/2018 08:37:30 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica Advantage Solution H6154-001 (HMO-POS)	01	02		1			H6154	001	0	2019	Minneapolis/St. Paul Metro Area		2	13422	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6154	002	0	1	02	01	H6154_002_0	9	1				05/31/2018	2019.01	05/31/2018 04:39:43 PM Central Daylight Time	08/02/2018 10:34:30 AM Central Daylight Time	08/01/2018 08:38:07 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica Advantage Solution H6154-002 (HMO-POS)	01	02		1			H6154	002	0	2019	Select Counties in MN		2	2154	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6188	001	0	1	20	08	H6188_001_0	1	1				05/23/2018	2019.01	05/23/2018 09:48:12 AM Eastern Daylight Time		05/23/2018 09:30:31 AM Eastern Daylight Time			05/23/2018 09:54:06 AM Eastern Daylight Time	VIECARE ARMSTRONG, LLC	LIFE Armstrong	www.lutheranseniorlife.org	VieCare Armstrong, LLC dba LIFE Armstrong County (PACE)	08	20		1			H6188	001	0	2019	Armstrong County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)545-8000				(724)545-8000												(711)-				(711)-																
H6188	002	0	1	20	08	H6188_002_0	1	1				05/23/2018	2019.01	05/23/2018 09:48:26 AM Eastern Daylight Time		05/23/2018 09:29:58 AM Eastern Daylight Time			05/23/2018 09:54:06 AM Eastern Daylight Time	VIECARE ARMSTRONG, LLC	LIFE Armstrong	www.lutheranseniorlife.org	VieCare Armstrong, LLC dba LIFE Armstrong County (PACE)	08	20		1			H6188	002	0	2019	Armstrong County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)545-8000				(724)545-8000												(711)-				(711)-																
H6229	005	0	1	48	05	H6229_005_0	2	1				07/03/2018	2019.01	07/03/2018 02:42:57 PM Pacific Daylight Time					07/03/2018 02:48:12 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	duals.caremore.com	CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)	05	48		1			H6229	005	0	2019	Los Angeles County (Partial)		2	42250	2			2						duals.caremore.com	duals.caremore.com	duals.caremore.com	(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6229	006	0	1	48	05	H6229_006_0	2	1				07/03/2018	2019.01	07/03/2018 03:02:33 PM Pacific Daylight Time					07/03/2018 03:05:30 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	mss.anthem.com/cammp	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H6229	006	0	2019	Santa Clara County		2	37686	2			2						mss.anthem.com/cammp	mss.anthem.com/cammp	mss.anthem.com/cammp	(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6231	001	0	1	20	08	H6231_001_0	4	1				05/23/2018	2019.01	05/23/2018 12:10:39 PM Central Daylight Time		05/24/2018 10:18:39 AM Central Daylight Time			05/24/2018 10:24:39 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.ololrmc.com	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	001	0	2019	PACE Baton Rouge		2		2			2						www.ololrmc.com	www.ololrmc.com										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604																
H6231	002	0	1	20	08	H6231_002_0	4	1				05/23/2018	2019.01	05/23/2018 12:11:15 PM Central Daylight Time		05/24/2018 10:18:50 AM Central Daylight Time			05/24/2018 10:24:39 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.fmolhs.org	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	002	0	2019	PACE Baton Rouge		2		2			2						www.ololrmc.com	www.ololrmc.com										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604																
H6237	004	0	1	01	01	H6237_004_0	8	1				07/23/2018	2019.01	07/23/2018 10:15:19 AM Mountain Daylight Time	08/02/2018 12:02:00 AM Mountain Daylight Time	08/02/2018 12:02:38 AM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	004	0	2019	Portland Metro Area and Clark County, WA		2	16416	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6237	005	0	1	01	01	H6237_005_0	8	1				07/23/2018	2019.01	07/23/2018 09:57:23 AM Mountain Daylight Time	08/02/2018 12:03:37 AM Mountain Daylight Time	08/02/2018 12:04:15 AM Mountain Daylight Time			08/06/2018 02:13:00 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	01	01		1			H6237	005	0	2019	Portland Metro Area and Clark County, WA		2	60672	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6237	803	0	1	01	01	H6237_803_0	1	1				05/15/2018	2019.01	05/15/2018 02:50:26 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	803	0	2019	Portland Metro Area and Clark County, WA		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H6237	804	0	1	01	01	H6237_804_0	1	1				05/18/2018	2019.01	05/18/2018 11:27:11 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO 02 (HMO)	01	01		1			H6237	804	0	2019	Portland Metro area/Clark Co, WA		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H6237	805	0	1	01	01	H6237_805_0	1	1				05/18/2018	2019.01	05/18/2018 11:45:14 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO 03 (HMO)	01	01		1			H6237	805	0	2019	Portland Metro area/Clark Co, WA		1	12	2			2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	1	7d;7f;7g;	1					1				
H6306	002	0	1	01	01	H6306_002_0	4	1				08/03/2018	2019.01	08/03/2018 03:15:24 PM Pacific Daylight Time	08/01/2018 04:48:36 PM Pacific Daylight Time	07/31/2018 03:46:20 PM Pacific Daylight Time			08/03/2018 06:15:37 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Plus (HMO)	01	01		1			H6306	002	0	2019	South Central North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	003	0	1	01	01	H6306_003_0	3	1				08/03/2018	2019.01	08/03/2018 06:12:54 PM Pacific Daylight Time	08/01/2018 04:49:51 PM Pacific Daylight Time	07/31/2018 03:47:04 PM Pacific Daylight Time			08/03/2018 06:15:37 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Standard (HMO)	01	01		1			H6306	003	0	2019	South Central North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	005	0	1	01	01	H6306_005_0	3	1				08/03/2018	2019.01	08/03/2018 06:12:44 PM Pacific Daylight Time	08/03/2018 08:28:50 AM Pacific Daylight Time	08/03/2018 08:05:17 AM Pacific Daylight Time			08/03/2018 06:15:37 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct smartHMO (HMO)	01	01		1			H6306	005	0	2019	Wake County		2	8400	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)499-5630		(844)499-5630		(855)903-5154		(855)903-5154		(844)499-5630		(844)499-5630		(844)499-5630		(844)499-5630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	006	0	1	01	01	H6306_006_0	3	1				08/03/2018	2019.01	08/03/2018 03:17:56 PM Pacific Daylight Time	08/03/2018 08:17:28 AM Pacific Daylight Time	08/03/2018 08:07:18 AM Pacific Daylight Time			08/03/2018 06:15:37 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct preferredPLUS (HMO)	01	01		1			H6306	006	0	2019	Wake County		2	3600	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)499-5630		(844)499-5630		(855)903-5154		(855)903-5154		(844)499-5630		(844)499-5630		(844)499-5630		(844)499-5630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	007	0	1	01	01	H6306_007_0	4	1				08/03/2018	2019.01	08/03/2018 03:15:45 PM Pacific Daylight Time	08/02/2018 10:19:09 AM Pacific Daylight Time	07/31/2018 03:47:31 PM Pacific Daylight Time			08/03/2018 06:15:37 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct Healthy State HMO Plus (HMO)	01	01		1			H6306	007	0	2019	Western North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	010	0	1	01	01	H6306_010_0	4	1				08/03/2018	2019.01	08/03/2018 03:15:51 PM Pacific Daylight Time	08/02/2018 10:20:37 AM Pacific Daylight Time	07/31/2018 03:47:59 PM Pacific Daylight Time			08/03/2018 06:15:37 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct Healthy State HMO Prime (HMO)	01	01		1			H6306	010	0	2019	Western North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6328	001	0	1	04	01	H6328_001_0	5	1				07/18/2018	2019.01	07/18/2018 05:25:27 PM Eastern Daylight Time	08/02/2018 01:13:25 PM Eastern Daylight Time	08/06/2018 12:46:37 PM Eastern Daylight Time			08/06/2018 02:53:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice Premium (PPO)	01	04		1			H6328	001	0	2019	Dallas/Fort Worth Metro Area		2	14800	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	002	0	1	04	01	H6328_002_0	5	1				07/18/2018	2019.01	07/18/2018 05:28:29 PM Eastern Daylight Time	08/02/2018 01:17:04 PM Eastern Daylight Time	08/06/2018 12:49:25 PM Eastern Daylight Time			08/06/2018 02:53:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice Plus (PPO)	01	04		1			H6328	002	0	2019	Dallas/Fort Worth Metro Area		2	45500	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	003	0	1	04	01	H6328_003_0	5	1				07/18/2018	2019.01	07/18/2018 05:30:07 PM Eastern Daylight Time	08/02/2018 01:20:45 PM Eastern Daylight Time	08/06/2018 12:51:51 PM Eastern Daylight Time			08/06/2018 02:53:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice (PPO)	01	04		1			H6328	003	0	2019	Dallas/Fort Worth Metro Area		2	84700	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	005	0	1	04	01	H6328_005_0	4	1				07/18/2018	2019.01	07/18/2018 05:31:31 PM Eastern Daylight Time	07/20/2018 01:58:49 PM Eastern Daylight Time				07/20/2018 02:27:35 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice MA-Only (PPO)	01	04		1			H6328	005	0	2019	Dallas/Fort Worth Metro Area		2	4400	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6328	801	0	1	04	01	H6328_801_0	1	1				04/17/2018	2019.01	04/17/2018 11:52:52 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice CY - MAPD (PPO)	01	04		1			H6328	801	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	802	0	1	04	01	H6328_802_0	1	1				04/17/2018	2019.01	04/17/2018 11:53:01 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice NCY - MAPD (PPO)	01	04		1			H6328	802	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	803	0	1	04	01	H6328_803_0	1	1				04/17/2018	2019.01	04/17/2018 11:53:09 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice CY - MA-Only (PPO)	01	04		1			H6328	803	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6328	804	0	1	04	01	H6328_804_0	1	1				04/17/2018	2019.01	04/17/2018 11:53:17 AM Eastern Daylight Time					06/04/2018 02:14:22 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice NCY - MA-Only (PPO)	01	04		1			H6328	804	0	2019	Nationwide		1	1	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6342	001	0	1	20	08	H6342_001_0	1	1				05/21/2018	2019.01	05/21/2018 10:56:28 AM Central Daylight Time		05/21/2018 11:21:37 AM Central Daylight Time			05/21/2018 11:29:05 AM Central Daylight Time	COMPLETE HEALTH WITH PACE	Complete Health with PACE	www.completehealthwithpace.org	Complete Health with PACE (PACE)	08	20		1			H6342	001	0	2019	Central Arkansas		2		2			2						www.CareKinesis.com	https://www.completehealthwithpace.org												(501)376-8852				(501)376-8852												(501)688-7462				(501)688-7462																
H6342	002	0	1	20	08	H6342_002_0	1	1				05/21/2018	2019.01	05/21/2018 10:57:02 AM Central Daylight Time		05/21/2018 11:19:18 AM Central Daylight Time			05/21/2018 11:29:05 AM Central Daylight Time	COMPLETE HEALTH WITH PACE	Complete Health with PACE	www.completehealthwithpace.org	Complete Health with PACE (PACE)	08	20		1			H6342	002	0	2019	Central Arkansas		2		2			2						www.CareKinesis.com	https://www.completehealthwithpace.org												(501)376-8852				(501)376-8852												(501)688-7462				(501)688-7462																
H6345	001	0	1	01	01	H6345_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:25:25 AM Eastern Daylight Time	08/07/2018 02:52:10 PM Eastern Daylight Time	08/07/2018 02:52:10 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	PruittHealth Premier (HMO SNP)	www.pruitthealthpremier.com	PruittHealth Premier (HMO SNP)	01	01		1			H6345	001	0	2019	NC (Partial) SC (Partial)		2	6703	2			1	1	3				www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6345	002	0	1	01	01	H6345_002_0	5	1		1		08/03/2018	2019.01	08/03/2018 09:25:56 AM Eastern Daylight Time	08/07/2018 02:52:10 PM Eastern Daylight Time	08/07/2018 02:52:11 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	PruittHealth Premier (HMO SNP)	www.pruitthealthpremier.com	PruittHealth Premier (HMO SNP)	01	01		1			H6345	002	0	2019	South Carolina (partial)		2	8641	2			1	1	3				www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6348	001	0	1	04	01	H6348_001_0	5	1				08/01/2018	2019.01	08/01/2018 05:07:44 PM US Mountain Standard Time	08/04/2018 12:50:38 PM Pacific Daylight Time	08/04/2018 12:50:48 PM Pacific Daylight Time			08/04/2018 01:28:41 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	01	04		1			H6348	001	0	2019	12 counties in Central Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	002	0	1	04	01	H6348_002_0	5	1				08/01/2018	2019.01	08/01/2018 05:08:00 PM US Mountain Standard Time	08/04/2018 12:51:06 PM Pacific Daylight Time	08/04/2018 12:51:18 PM Pacific Daylight Time			08/04/2018 01:28:41 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	01	04		1			H6348	002	0	2019	Allen, Elkhart, St Joseph, Wells, Whitley		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	003	0	1	04	01	H6348_003_0	4	1				08/01/2018	2019.01	08/01/2018 04:43:58 PM US Mountain Standard Time	08/04/2018 12:51:30 PM Pacific Daylight Time	08/04/2018 12:51:37 PM Pacific Daylight Time			08/04/2018 01:28:41 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	01	04		1			H6348	003	0	2019	Vanderburgh, Posey, Warrick		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	004	0	1	04	01	H6348_004_0	4	1				08/01/2018	2019.01	08/01/2018 04:46:31 PM US Mountain Standard Time	08/04/2018 12:51:50 PM Pacific Daylight Time	08/04/2018 12:51:55 PM Pacific Daylight Time			08/04/2018 01:28:41 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	01	04		1			H6348	004	0	2019	Lake, Laporte, and Porter Counties		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	801	0	1	04	01	H6348_801_0	1	1				05/29/2018	2019.01	05/29/2018 04:43:55 PM Pacific Daylight Time					06/03/2018 12:56:19 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	801	0	2019	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H6348	802	0	1	04	01	H6348_802_0	1	1				05/29/2018	2019.01	05/29/2018 05:30:16 PM Pacific Daylight Time					06/03/2018 12:56:19 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	802	0	2019	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H6348	803	0	1	04	01	H6348_803_0	1	1				05/29/2018	2019.01	05/29/2018 04:44:07 PM Pacific Daylight Time					06/03/2018 12:56:19 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	803	0	2019	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H6351	001	0	1	01	01	H6351_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:27:43 AM Eastern Daylight Time	08/07/2018 02:52:11 PM Eastern Daylight Time	08/07/2018 02:52:11 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Advantage (HMO SNP)	www.libertyadvantageplan.com	Liberty Advantage (HMO SNP)	01	01		1			H6351	001	0	2019	North Carolina (partial)		2	6648	2			1	1	3				www.libertyadvantageplan.com	www.libertyadvantageplan.com	www.libertyadvantageplan.com	(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6351	002	0	1	01	01	H6351_002_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:35:29 AM Eastern Daylight Time	08/07/2018 02:52:11 PM Eastern Daylight Time	08/07/2018 02:52:12 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Advantage (HMO SNP)	www.libertyadvantageplan.com	Liberty Advantage Gold (HMO SNP)	01	01		1			H6351	002	0	2019	North Carolina (partial)		2	394	2			1	1	3				www.libertyadvantageplan.com	www.libertyadvantageplan.com	www.libertyadvantageplan.com	(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6351	003	0	1	01	01	H6351_003_0	5	1		1		08/03/2018	2019.01	08/03/2018 09:36:19 AM Eastern Daylight Time	08/07/2018 02:52:12 PM Eastern Daylight Time	08/07/2018 02:52:12 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Advantage (HMO SNP)	www.libertyadvantageplan.com	Liberty at Home (HMO SNP)	01	01		1			H6351	003	0	2019	North Carolina (partial)		2	240	2			1	1	3				www.libertyadvantageplan.com	www.libertyadvantageplan.com	www.libertyadvantageplan.com	(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6371	001	0	1	20	08	H6371_001_0	1	1				05/30/2018	2019.01	05/30/2018 06:43:39 PM Eastern Daylight Time		05/30/2018 06:38:14 PM Eastern Daylight Time			05/30/2018 06:45:38 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	001	0	2019	Lutheran Senior LIFE Hudson County		2		2			2						www.lifelsmnj.org	www.lifelsmnj.org										(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091										(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091																
H6371	002	0	1	20	08	H6371_002_0	1	1				05/30/2018	2019.01	05/30/2018 06:44:03 PM Eastern Daylight Time		05/30/2018 06:38:03 PM Eastern Daylight Time			05/30/2018 06:45:38 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	002	0	2019	Lutheran Senior LIFE Hudson County		2		2			2						www.lifelsmnj.org	www.lifelsmnj.org										(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091										(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091																
H6396	001	0	1	01	01	H6396_001_0	9	1				08/07/2018	2019.01	08/07/2018 08:58:46 AM Eastern Daylight Time	08/07/2018 02:30:16 PM Eastern Daylight Time	08/03/2018 02:54:56 PM Eastern Daylight Time			08/07/2018 04:35:37 PM Eastern Daylight Time	CARESOURCE	CareSource	www.caresource.com/medicare	CareSource Advantage (HMO)	01	01		1			H6396	001	0	2019	Ohio		2	38183	2			2						http:\\caresource.com	www.caresource.com/medicare	https://memberportal.caresource.com/App/OH/FindADoctor/MA	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H6396	002	0	1	01	01	H6396_002_0	9	1				07/18/2018	2019.01	07/18/2018 04:46:27 PM Eastern Daylight Time	08/07/2018 02:34:06 PM Eastern Daylight Time	08/03/2018 02:56:54 PM Eastern Daylight Time			08/07/2018 04:35:37 PM Eastern Daylight Time	CARESOURCE	CareSource	www.caresource.com/medicare	CareSource Advantage Plus (HMO)	01	01		1			H6396	002	0	2019	Ohio		2	16798	2			2						http:\\caresource.com	www.caresource.com/medicare	https://memberportal.caresource.com/App/OH/FindADoctor/MA	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H6396	004	0	1	01	01	H6396_004_0	9	1				05/29/2018	2019.01	05/29/2018 09:43:45 AM Eastern Daylight Time	08/07/2018 02:38:00 PM Eastern Daylight Time	08/03/2018 02:59:28 PM Eastern Daylight Time			08/07/2018 04:35:37 PM Eastern Daylight Time	CARESOURCE	CareSource	www.caresource.com/medicare	CareSource Advantage Zero Premium (HMO)	01	01		1			H6396	004	0	2019	Ohio		2	22878	2			2						http:\\caresource.com	www.caresource.com/medicare	https://memberportal.caresource.com/App/OH/FindADoctor/MA	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H6435	001	0	1	48	05	H6435_001_0	3	1				07/31/2018	2019.01	07/31/2018 05:02:56 PM Eastern Daylight Time					07/31/2018 05:03:25 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring FIDA Plan	www.riverspringFIDA.org	RiverSpring FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H6435	001	0	2019	Brx, Ki, Na, NY, Qu, Ri, Wes		2	240	2			2						www.riverspringFIDA.org	www.riverspringFIDA.org	www.riverspringFIDA.org	(800)950-9000		(800)950-9000		(800)950-9000		(800)950-9000		(855)898-1482		(855)898-1482		(855)898-1482		(855)898-1482		(711)-		(711)-		(711)-		(711)-		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
H6439	002	0	1	01	01	H6439_002_0	4	1				08/03/2018	2019.01	08/03/2018 01:17:20 PM Eastern Daylight Time	08/06/2018 05:58:17 PM Eastern Daylight Time	08/01/2018 02:48:00 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF ARIZONA, INC.	WellCare	www.care1staz.com/az/healthplans/onecare	WellCare Value (HMO)	01	01		1			H6439	002	0	2019	Selected AZ Counties		2	33588	2			2						www.care1staz.com/az/healthplans/onecare	www.care1staz.com/az/healthplans/onecare	www.care1staz.com/az/healthplans/onecare	(866)797-2641		(866)797-2641		(866)527-0056		(866)527-0056		(866)797-2641		(866)797-2641		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	001	0	1	01	01	H6453_001_0	8	1				08/09/2018	2019.01	08/09/2018 01:19:07 PM Central Daylight Time	08/06/2018 04:29:11 PM Central Daylight Time	08/06/2018 04:28:37 PM Central Daylight Time			08/10/2018 02:51:09 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	001	0	2019	Baton Rouge		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	002	0	1	01	01	H6453_002_0	8	1				08/09/2018	2019.01	08/09/2018 01:25:43 PM Central Daylight Time	08/06/2018 04:29:12 PM Central Daylight Time	08/06/2018 04:28:37 PM Central Daylight Time			08/10/2018 02:51:09 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	002	0	2019	Greater New Orleans		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	003	0	1	01	01	H6453_003_0	8	1				08/09/2018	2019.01	08/09/2018 01:29:28 PM Central Daylight Time	08/06/2018 04:29:13 PM Central Daylight Time	08/06/2018 04:28:38 PM Central Daylight Time			08/10/2018 02:51:09 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	003	0	2019	North Shore		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	004	0	1	01	01	H6453_004_0	8	1				08/09/2018	2019.01	08/09/2018 01:32:54 PM Central Daylight Time	08/06/2018 04:29:14 PM Central Daylight Time	08/06/2018 04:28:38 PM Central Daylight Time			08/10/2018 02:51:09 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	004	0	2019	Acadiana		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	005	0	1	01	01	H6453_005_0	8	1				08/09/2018	2019.01	08/09/2018 01:38:21 PM Central Daylight Time	08/06/2018 04:29:16 PM Central Daylight Time	08/06/2018 04:28:39 PM Central Daylight Time			08/10/2018 02:51:09 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	005	0	2019	Northwest		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	006	0	1	01	01	H6453_006_0	8	1				08/09/2018	2019.01	08/09/2018 01:40:24 PM Central Daylight Time	08/06/2018 04:29:17 PM Central Daylight Time	08/06/2018 04:28:40 PM Central Daylight Time			08/10/2018 02:51:09 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	006	0	2019	Northeast		2		2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	801	0	1	01	01	H6453_801_0	4	1				05/22/2018	2019.01	05/22/2018 09:17:20 AM Central Daylight Time					06/04/2018 01:14:49 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	801	0	2019	State of Louisiana		1	250	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1				
H6453	802	0	1	01	01	H6453_802_0	4	1				05/14/2018	2019.01	05/14/2018 03:30:19 PM Central Daylight Time					06/04/2018 01:14:49 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	802	0	2019	State of Louisiana		1	250	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1				
H6453	803	0	1	01	01	H6453_803_0	4	1				05/14/2018	2019.01	05/14/2018 03:31:16 PM Central Daylight Time					06/04/2018 01:14:49 PM Central Daylight Time	HMO LOUISIANA, INC.	HMO Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	803	0	2019	State of Louisiana		1	250	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1				
H6502	001	0	1	04	01	H6502_001_0	3	1				08/05/2018	2019.01	08/05/2018 10:28:18 PM Central Daylight Time	08/06/2018 04:44:25 PM Central Daylight Time	08/06/2018 04:44:26 PM Central Daylight Time			08/06/2018 04:50:25 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Access (PPO)	01	04		1			H6502	001	0	2019	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6502	002	0	1	04	01	H6502_002_0	3	1				08/05/2018	2019.01	08/05/2018 10:44:32 PM Central Daylight Time	08/06/2018 04:44:26 PM Central Daylight Time	08/06/2018 04:44:27 PM Central Daylight Time			08/06/2018 04:50:25 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Essential (PPO)	01	04		1			H6502	002	0	2019	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6502	801	0	1	04	01	H6502_801_0	1	1				06/01/2018	2019.01	06/01/2018 04:03:01 PM Central Daylight Time					06/01/2018 04:46:03 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group MA-CY (PPO)	01	04		1			H6502	801	0	2019	Kansas City Area		1	7200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7b;7e;7g;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H6502	802	0	1	04	01	H6502_802_0	1	1				06/01/2018	2019.01	06/01/2018 04:04:35 PM Central Daylight Time					06/01/2018 04:46:03 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group MAPD - CY (PPO)	01	04		1			H6502	802	0	2019	Kansas City Area		1	7200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7b;7e;7g;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H6502	803	0	1	04	01	H6502_803_0	1	1				06/01/2018	2019.01	06/01/2018 04:05:03 PM Central Daylight Time					06/01/2018 04:46:03 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group MAPD - BY (PPO)	01	04		1			H6502	803	0	2019	Kansas City Area		1	7200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;5;7b;7e;7g;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H6526	001	0	1	01	01	H6526_001_0	6	1				08/10/2018	2019.01	08/10/2018 09:59:07 AM Central Daylight Time	08/10/2018 09:50:39 AM Central Daylight Time	07/31/2018 07:50:42 PM Central Daylight Time			08/10/2018 02:34:07 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW MEXICO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H6526	001	0	2019	Bernalillo, Sandoval, and Valencia counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6526	002	0	1	01	01	H6526_002_0	5	1				08/02/2018	2019.01	08/02/2018 01:29:42 PM Central Daylight Time	08/03/2018 09:50:50 AM Central Daylight Time	07/31/2018 07:51:04 PM Central Daylight Time			08/06/2018 09:43:46 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW MEXICO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H6526	002	0	2019	Santa Fe Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6528	006	0	1	04	01	H6528_006_0	3	1				07/12/2018	2019.01	07/12/2018 06:40:57 PM Central Daylight Time	08/03/2018 09:51:32 AM Central Daylight Time	07/31/2018 07:51:30 PM Central Daylight Time			08/06/2018 08:22:28 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Plan 1 (PPO)	01	04		1			H6528	006	0	2019	Select counties in Georgia		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6550	001	0	1	01	01	H6550_001_0	4	1				08/04/2018	2019.01	08/04/2018 10:51:46 AM Pacific Daylight Time	08/04/2018 10:34:33 AM Pacific Daylight Time	08/04/2018 10:36:32 AM Pacific Daylight Time			08/04/2018 11:13:16 AM Pacific Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Allwell	allwell.sunflowerhealthplan.com	Allwell Medicare (HMO)	01	01		1			H6550	001	0	2019	Johnson, Leavenworth, Miami, Wyandotte		2		2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	003	0	1	01	01	H6550_003_0	4	1				08/02/2018	2019.01	08/02/2018 09:12:35 AM Pacific Daylight Time	08/04/2018 10:38:00 AM Pacific Daylight Time	08/04/2018 10:39:49 AM Pacific Daylight Time			08/04/2018 11:13:16 AM Pacific Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Allwell	allwell.sunflowerhealthplan.com	Allwell Medicare (HMO)	01	01		1			H6550	003	0	2019	Cherokee, Crawford, Sedgwick		2		2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	004	0	1	01	01	H6550_004_0	4	1	2	1		08/03/2018	2019.01	08/03/2018 10:53:27 AM Pacific Daylight Time	08/04/2018 10:42:02 AM Pacific Daylight Time	08/04/2018 10:43:05 AM Pacific Daylight Time			08/04/2018 11:13:16 AM Pacific Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Allwell	allwell.sunflowerhealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H6550	004	0	2019	Counties  CK, CR, JO, LV, MI, SG, WY		2		2			1	3		1		1	allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	801	0	1	01	01	H6550_801_0	1	1				05/29/2018	2019.01	05/29/2018 04:44:37 PM Pacific Daylight Time					06/03/2018 03:39:16 PM Pacific Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	801	0	2019	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6550	802	0	1	01	01	H6550_802_0	1	1				05/29/2018	2019.01	05/29/2018 04:44:42 PM Pacific Daylight Time					06/03/2018 03:39:16 PM Pacific Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	802	0	2019	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6550	803	0	1	01	01	H6550_803_0	1	1				05/29/2018	2019.01	05/29/2018 05:30:23 PM Pacific Daylight Time					06/03/2018 03:39:16 PM Pacific Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	803	0	2019	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6551	001	0	1	20	08	H6551_001_0	1	1				05/29/2018	2019.01	05/29/2018 08:19:51 AM Eastern Daylight Time		05/29/2018 08:11:29 AM Eastern Daylight Time			05/29/2018 08:23:31 AM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	http://www.lifestmary.org/	LIFE St. Mary (PACE)	08	20		1			H6551	001	0	2019	Bucks County and Partical Montgomery County		2		2			2						stmaryhealthcare.org	stmaryhealthcare.org										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601																
H6551	002	0	1	20	08	H6551_002_0	1	1				05/29/2018	2019.01	05/29/2018 08:20:28 AM Eastern Daylight Time		05/29/2018 08:11:11 AM Eastern Daylight Time			05/29/2018 08:23:31 AM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	www.lifestmary.org	LIFE St. Mary (PACE)	08	20		1			H6551	002	0	2019	Bucks County and Partical Montgomery County		2		2			2						stmaryhealthcare.org	stmaryhealthcare.org										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601																
H6595	001	0	1	01	01	H6595_001_0	4	1	2	1		05/29/2018	2019.01	05/29/2018 02:11:27 PM Central Daylight Time	08/03/2018 11:25:21 AM Central Daylight Time	07/31/2018 07:51:56 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE OF KENTUCKY, LTD.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H6595	001	0	2019	Select Counties in Kentucky		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6596	001	0	1	20	08	H6596_001_0	1	1				06/01/2018	2019.01	06/01/2018 02:11:15 PM Eastern Daylight Time		06/04/2018 04:04:15 PM Eastern Daylight Time			06/04/2018 04:14:53 PM Eastern Daylight Time	FALLON HEALTH WEINBERG, INC.	Fallon Health Weinberg-PACE	fallonweinberg.org	Fallon Health Weinberg-PACE (PACE)	08	20		1			H6596	001	0	2019	Erie County		2	2220	2			2						Not applicable	Not applicable										(855)665-1113		(716)810-1895		(855)665-1113		(716)810-1895										(711)-		(711)-		(711)-		(711)-																
H6596	002	0	1	20	08	H6596_002_0	1	1				05/10/2018	2019.01	05/10/2018 05:39:22 PM Eastern Daylight Time		06/04/2018 04:04:30 PM Eastern Daylight Time			06/04/2018 04:14:53 PM Eastern Daylight Time	FALLON HEALTH WEINBERG, INC.	Fallon Health Weinberg-PACE	fallonweinberg.org	Fallon Health Weinberg-PACE (PACE)	08	20		1			H6596	002	0	2019	Erie County		2	18	2			2						Not applicable	Not applicable										(855)665-1113		(716)810-1895		(855)665-1113		(716)810-1895										(711)-		(711)-		(711)-		(711)-																
H6622	001	0	1	01	01	H6622_001_0	5	1				07/02/2018	2019.01	07/02/2018 04:50:45 PM Eastern Daylight Time	07/18/2018 02:58:43 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-001 (HMO)	01	01		1			H6622	001	0	2019	Green Bay area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	002	0	1	01	01	H6622_002_0	5	1				07/02/2018	2019.01	07/02/2018 04:51:05 PM Eastern Daylight Time	07/18/2018 02:59:11 PM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-002 (HMO)	01	01		1			H6622	002	0	2019	Milwaukee area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	004	0	1	01	01	H6622_004_0	5	1				07/18/2018	2019.01	07/18/2018 05:20:09 PM Eastern Daylight Time	07/17/2018 10:14:10 AM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:19:59 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-004 (HMO)	01	01		1			H6622	004	0	2019	Richmond Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	005	0	1	01	01	H6622_005_0	5	1				07/18/2018	2019.01	07/18/2018 05:20:25 PM Eastern Daylight Time	07/17/2018 10:14:42 AM Eastern Daylight Time	08/03/2018 09:21:20 AM Eastern Daylight Time			08/06/2018 10:19:59 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-005 (HMO)	01	01		1			H6622	005	0	2019	Tidewater Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	007	0	1	01	01	H6622_007_0	5	1				07/02/2018	2019.01	07/02/2018 04:51:34 PM Eastern Daylight Time	07/18/2018 03:03:12 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-007 (HMO)	01	01		1			H6622	007	0	2019	Select Counties in Montana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	008	0	1	01	01	H6622_008_0	5	1	2	1		07/02/2018	2019.01	07/02/2018 04:51:58 PM Eastern Daylight Time	07/18/2018 03:05:37 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:11:54 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-008 (HMO SNP)	01	01		1			H6622	008	0	2019	Select Counties in Montana		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	010	0	1	01	01	H6622_010_0	5	1				07/18/2018	2019.01	07/18/2018 05:33:55 PM Eastern Daylight Time	07/17/2018 10:16:50 AM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:49:10 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-010 (HMO)	01	01		1			H6622	010	0	2019	Kent, New Castle and Sussex Counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	011	0	1	01	01	H6622_011_0	3	1				07/02/2018	2019.01	07/02/2018 05:50:00 PM Eastern Daylight Time	06/01/2018 01:03:18 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-011 (HMO)	01	01		1			H6622	011	0	2019	Cleveland Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	012	0	1	01	01	H6622_012_0	3	1				07/02/2018	2019.01	07/02/2018 05:48:53 PM Eastern Daylight Time	06/01/2018 01:03:57 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-012 (HMO)	01	01		1			H6622	012	0	2019	Dayton Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	013	0	1	01	01	H6622_013_0	3	1				07/02/2018	2019.01	07/02/2018 05:47:54 PM Eastern Daylight Time	08/03/2018 01:36:58 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:38:58 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-013 (HMO)	01	01		1			H6622	013	0	2019	Columbus Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	014	0	1	01	01	H6622_014_0	4	1				07/18/2018	2019.01	07/18/2018 05:31:01 PM Eastern Daylight Time	08/03/2018 01:37:32 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-014 (HMO)	01	01		1			H6622	014	0	2019	Canton-Akron Metro Areas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	015	0	1	01	01	H6622_015_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:40:40 PM Eastern Daylight Time	07/17/2018 12:49:12 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-015 (HMO SNP)	01	01		1			H6622	015	0	2019	Select counties in Ohio		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	016	0	1	01	01	H6622_016_0	3	1				07/02/2018	2019.01	07/02/2018 05:43:33 PM Eastern Daylight Time	06/01/2018 01:10:22 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-016 (HMO)	01	01		1			H6622	016	0	2019	Select Counties in Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	017	0	1	01	01	H6622_017_0	3	1		1		07/03/2018	2019.01	07/03/2018 09:29:05 AM Eastern Daylight Time	06/01/2018 01:11:36 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H6622	017	0	2019	Cincinnati and Columbus area		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	018	0	1	01	01	H6622_018_0	3	1	2	1		07/03/2018	2019.01	07/03/2018 09:30:23 AM Eastern Daylight Time	08/03/2018 01:38:42 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-018 (HMO SNP)	01	01		1			H6622	018	0	2019	Northern Kentucky Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	019	0	1	01	01	H6622_019_0	6	1				07/18/2018	2019.01	07/18/2018 05:29:27 PM Eastern Daylight Time	06/01/2018 01:17:32 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-019 (HMO)	01	01		1			H6622	019	0	2019	Select Counties in Ohio and Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	021	1	1	01	01	H6622_021_1	3	1				07/02/2018	2019.01	07/02/2018 05:40:10 PM Eastern Daylight Time	06/01/2018 01:15:46 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-021 (HMO)	01	01		1			H6622	021	1	2019	Select OH counties in Cincinnati Metro Area	Select KY counties in Cincinnati Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	021	2	1	01	01	H6622_021_2	3	1				07/02/2018	2019.01	07/02/2018 05:37:18 PM Eastern Daylight Time	06/01/2018 01:16:21 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-021 (HMO)	01	01		1			H6622	021	2	2019	Select OH counties in Cincinnati Metro Area	Select OH counties in Cincinnati Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	022	0	1	01	01	H6622_022_0	3	1				07/02/2018	2019.01	07/02/2018 05:29:14 PM Eastern Daylight Time	08/03/2018 01:39:50 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-022 (HMO)	01	01		1			H6622	022	0	2019	Select counties in Cleveland		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	023	0	1	01	01	H6622_023_0	5	1				07/02/2018	2019.01	07/02/2018 05:27:52 PM Eastern Daylight Time	06/01/2018 01:47:50 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:45:18 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Cleveland Clinic Preferred (HMO)	01	01		1			H6622	023	0	2019	Select counties in Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	024	0	1	01	01	H6622_024_0	3	1	2	1		07/03/2018	2019.01	07/03/2018 09:31:37 AM Eastern Daylight Time	06/01/2018 01:26:31 PM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:50:53 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Cleveland Clinic Preferred SNP-DE (HMO SNP)	01	01		1			H6622	024	0	2019	Cuyahoga County		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	025	0	1	01	01	H6622_025_0	4	1				07/03/2018	2019.01	07/03/2018 11:17:16 AM Eastern Daylight Time	07/17/2018 10:21:58 AM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:49:10 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-025 (HMO)	01	01		1			H6622	025	0	2019	Western North Carolina Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	026	0	1	01	01	H6622_026_0	5	1				07/03/2018	2019.01	07/03/2018 11:18:04 AM Eastern Daylight Time	08/03/2018 09:54:49 AM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:49:10 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-026 (HMO)	01	01		1			H6622	026	0	2019	Western North Carolina Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	027	0	1	01	01	H6622_027_0	4	1	2	1		07/02/2018	2019.01	07/02/2018 04:11:28 PM Eastern Daylight Time	08/03/2018 09:55:18 AM Eastern Daylight Time	08/03/2018 09:21:21 AM Eastern Daylight Time			08/06/2018 10:49:10 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-027 (HMO SNP)	01	01		1			H6622	027	0	2019	Western North Carolina Area		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	028	0	1	01	01	H6622_028_0	4	1				07/02/2018	2019.01	07/02/2018 01:11:55 PM Eastern Daylight Time	07/18/2018 01:55:56 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:11:43 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-028 (HMO)	01	01		1			H6622	028	0	2019	Clark and Nye (partial) counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	029	0	1	01	01	H6622_029_0	6	1		1		07/02/2018	2019.01	07/02/2018 01:13:18 PM Eastern Daylight Time	07/18/2018 01:54:42 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:11:43 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H6622	029	0	2019	Clark and Nye (partial) counties		2		2			1	4			00000000000000000010		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	030	0	1	01	01	H6622_030_0	4	1		1		07/02/2018	2019.01	07/02/2018 01:14:43 PM Eastern Daylight Time	07/18/2018 01:55:23 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:11:43 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-CLD H6622-030 (HMO SNP)	01	01		1			H6622	030	0	2019	Clark and Nye (partial) counties		2		2			1	4			00000000000100000000		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	031	0	1	01	01	H6622_031_0	6	1		1		07/02/2018	2019.01	07/02/2018 03:51:47 PM Eastern Daylight Time		08/03/2018 09:21:22 AM Eastern Daylight Time		06/08/2018 09:00:24 AM Eastern Daylight Time	08/06/2018 10:11:43 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Kidney Care (HMO SNP)	01	01		1			H6622	031	0	2019	Clark and Nye (partial) counties		2		2			1	4			00000000100000000000		http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	032	0	1	01	01	H6622_032_0	3	1				07/02/2018	2019.01	07/02/2018 01:11:47 PM Eastern Daylight Time	06/01/2018 03:03:35 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:21:17 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-032 (HMO)	01	01		1			H6622	032	0	2019	Select counties in Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	033	0	1	01	01	H6622_033_0	3	1				07/02/2018	2019.01	07/02/2018 01:11:58 PM Eastern Daylight Time	06/01/2018 03:05:11 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:21:17 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-033 (HMO)	01	01		1			H6622	033	0	2019	Select counties in Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	034	0	1	01	01	H6622_034_0	5	1				07/02/2018	2019.01	07/02/2018 04:52:44 PM Eastern Daylight Time	07/18/2018 03:10:32 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:44:56 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-034 (HMO)	01	01		1			H6622	034	0	2019	Milwaukee area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	035	0	1	01	01	H6622_035_0	4	1				07/18/2018	2019.01	07/18/2018 05:49:16 PM Eastern Daylight Time	06/01/2018 01:37:16 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-035 (HMO)	01	01		1			H6622	035	0	2019	Central-Western Pennsylvania area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	036	0	1	01	01	H6622_036_0	4	1				07/18/2018	2019.01	07/18/2018 06:02:58 PM Eastern Daylight Time	06/01/2018 01:37:43 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-036 (HMO)	01	01		1			H6622	036	0	2019	Northeast Pennsylvania Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	037	0	1	01	01	H6622_037_0	4	1				07/18/2018	2019.01	07/18/2018 06:04:16 PM Eastern Daylight Time	06/01/2018 01:38:11 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-037 (HMO)	01	01		1			H6622	037	0	2019	Greater Philadelphia Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	038	0	1	01	01	H6622_038_0	3	1	2	1		07/03/2018	2019.01	07/03/2018 09:48:08 AM Eastern Daylight Time	06/01/2018 01:42:21 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-038 (HMO SNP)	01	01		1			H6622	038	0	2019	Select counties in Pennsylvania		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	039	0	1	01	01	H6622_039_0	3	1				07/02/2018	2019.01	07/02/2018 12:27:12 PM Eastern Daylight Time	06/01/2018 01:45:34 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-039 (HMO)	01	01		1			H6622	039	0	2019	Greater Philadelphia Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	040	0	1	01	01	H6622_040_0	5	1				07/02/2018	2019.01	07/02/2018 04:53:45 PM Eastern Daylight Time	07/18/2018 03:11:59 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:44:56 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-040 (HMO)	01	01		1			H6622	040	0	2019	Milwaukee area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	041	0	1	01	01	H6622_041_0	4	1				07/02/2018	2019.01	07/02/2018 04:02:39 PM Eastern Daylight Time	07/17/2018 10:23:58 AM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:19:59 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-041 (HMO)	01	01		1			H6622	041	0	2019	Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	043	0	1	01	01	H6622_043_0	3	1				07/02/2018	2019.01	07/02/2018 12:28:22 PM Eastern Daylight Time	06/01/2018 01:48:47 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:40:05 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-043 (HMO)	01	01		1			H6622	043	0	2019	South Central-Northeast Pennsylvania area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	047	0	1	01	01	H6622_047_0	4	1				07/02/2018	2019.01	07/02/2018 11:44:55 AM Eastern Daylight Time	06/01/2018 03:26:31 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-047 (HMO)	01	01		1			H6622	047	0	2019	Hattiesburg		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	048	0	1	01	01	H6622_048_0	4	1	2	1		08/02/2018	2019.01	08/02/2018 11:21:55 AM Eastern Daylight Time	08/03/2018 12:40:49 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:15:28 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-048 (HMO SNP)	01	01		1			H6622	048	0	2019	Hattiesburg		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	049	0	1	01	01	H6622_049_0	3	1				07/02/2018	2019.01	07/02/2018 03:52:37 PM Eastern Daylight Time	06/01/2018 03:18:03 PM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:21:17 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-049 (HMO)	01	01		1			H6622	049	0	2019	Select counties in Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	050	1	1	01	01	H6622_050_1	4	1				07/20/2018	2019.01	07/20/2018 11:02:56 AM Eastern Daylight Time	07/20/2018 09:56:11 AM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:19:59 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-050 (HMO)	01	01		1			H6622	050	1	2019	Richmond - Tidewater Area	Richmond Metro Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	050	2	1	01	01	H6622_050_2	4	1				07/02/2018	2019.01	07/02/2018 04:03:11 PM Eastern Daylight Time	07/17/2018 10:28:57 AM Eastern Daylight Time	08/03/2018 09:21:22 AM Eastern Daylight Time			08/06/2018 10:19:59 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-050 (HMO)	01	01		1			H6622	050	2	2019	Richmond - Tidewater Area	Richmond - Tidewater Area	2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	051	0	1	01	01	H6622_051_0	4	1	2	1		07/16/2018	2019.01	07/16/2018 01:09:08 PM Eastern Daylight Time	07/17/2018 10:27:53 AM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:49:10 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-051 (HMO SNP)	01	01		1			H6622	051	0	2019	Kent, New Castle and Sussex Counties		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	052	0	1	01	01	H6622_052_0	4	1				07/18/2018	2019.01	07/18/2018 05:57:15 PM Eastern Daylight Time	08/03/2018 03:32:58 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 11:20:08 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-052 (HMO)	01	01		1			H6622	052	0	2019	Guthrie		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	053	0	1	01	01	H6622_053_0	4	1				07/18/2018	2019.01	07/18/2018 05:58:48 PM Eastern Daylight Time	08/03/2018 03:33:59 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 11:20:08 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-053 (HMO)	01	01		1			H6622	053	0	2019	Pittsburgh		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	054	0	1	01	01	H6622_054_0	4	1				07/18/2018	2019.01	07/18/2018 06:00:10 PM Eastern Daylight Time	06/01/2018 01:49:13 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 11:20:08 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-054 (HMO)	01	01		1			H6622	054	0	2019	Pittsburgh		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	055	0	1	01	01	H6622_055_0	4	1				07/18/2018	2019.01	07/18/2018 05:40:48 PM Eastern Daylight Time	06/01/2018 01:31:57 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-055 (HMO)	01	01		1			H6622	055	0	2019	Select counties in Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	056	0	1	01	01	H6622_056_0	5	1				07/18/2018	2019.01	07/18/2018 05:27:02 PM Eastern Daylight Time	07/18/2018 02:06:39 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:11:43 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-056 (HMO)	01	01		1			H6622	056	0	2019	Clark and Nye (partial) counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	057	0	1	01	01	H6622_057_0	5	1				07/18/2018	2019.01	07/18/2018 05:29:09 PM Eastern Daylight Time	07/17/2018 10:35:01 AM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:49:10 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-057 (HMO)	01	01		1			H6622	057	0	2019	Charlotte Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	058	0	1	01	01	H6622_058_0	4	1				07/03/2018	2019.01	07/03/2018 11:20:02 AM Eastern Daylight Time	07/17/2018 10:35:37 AM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:49:10 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-058 (HMO)	01	01		1			H6622	058	0	2019	Charlotte Metro Area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	801	0	1	01	01	H6622_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:46:20 PM Eastern Daylight Time					05/31/2018 01:46:43 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	801	0	2019	Select counties in Multi States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6622	802	0	1	01	01	H6622_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:46:02 PM Eastern Daylight Time					05/31/2018 01:46:43 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	802	0	2019	Select counties in Multi States		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6672	001	0	1	01	01	H6672_001_0	8	1	2	1		07/05/2018	2019.01	07/05/2018 01:20:59 PM Eastern Daylight Time	08/03/2018 09:19:22 AM Eastern Daylight Time	08/03/2018 10:05:25 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (GA)	Eon Health	www.eonhealthplan.com	EON DELUXE (HMO SNP)	01	01		1			H6672	001	0	2019	Select Georgia Counties		2		2			1	3		1		1	www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	003	0	1	01	01	H6672_003_0	7	1		1		07/05/2018	2019.01	07/05/2018 01:21:19 PM Eastern Daylight Time	08/03/2018 09:18:10 AM Eastern Daylight Time	08/03/2018 10:04:40 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (GA)	Eon Health	www.eonhealthplan.com	EON SILVER (HMO SNP)	01	01		1			H6672	003	0	2019	Select Georgia Counties		2		2			1	4			00000000000000000010		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	004	0	1	01	01	H6672_004_0	8	1				07/05/2018	2019.01	07/05/2018 01:21:38 PM Eastern Daylight Time	08/03/2018 09:16:43 AM Eastern Daylight Time	08/03/2018 10:02:41 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (GA)	Eon Health	www.eonhealthplan.com	EON SELECT (HMO)	01	01		1			H6672	004	0	2019	Select Georgia Counties		2		2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	1	1	01	01	H6723_001_1	12	1				07/12/2018	2019.01	07/12/2018 08:38:44 AM Eastern Daylight Time	08/06/2018 12:39:13 PM Eastern Daylight Time	08/06/2018 12:39:00 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	1	2019	Ohio Regions	Region 1	2	155922	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	2	1	01	01	H6723_001_2	9	1				07/12/2018	2019.01	07/12/2018 08:39:02 AM Eastern Daylight Time	08/06/2018 12:39:14 PM Eastern Daylight Time	08/06/2018 12:39:01 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	2	2019	Ohio Regions	Region 2	2	51475	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	1	1	01	01	H6723_002_1	8	1				07/12/2018	2019.01	07/12/2018 08:39:41 AM Eastern Daylight Time	08/06/2018 12:39:15 PM Eastern Daylight Time	08/06/2018 12:39:02 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	1	2019	Ohio Regions	Region 1	2	81124	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	2	1	01	01	H6723_002_2	8	1				07/12/2018	2019.01	07/12/2018 08:39:55 AM Eastern Daylight Time	08/06/2018 12:39:16 PM Eastern Daylight Time	08/06/2018 12:39:03 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	2	2019	Ohio Regions	Region 2	2	7138	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	1	1	01	01	H6723_003_1	8	1				07/12/2018	2019.01	07/12/2018 08:40:16 AM Eastern Daylight Time	08/06/2018 12:39:17 PM Eastern Daylight Time	08/06/2018 12:39:04 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	1	2019	Ohio Regions	Region 1	2	26836	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	2	1	01	01	H6723_003_2	8	1				07/12/2018	2019.01	07/12/2018 08:40:45 AM Eastern Daylight Time	08/06/2018 12:39:18 PM Eastern Daylight Time	08/06/2018 12:39:06 PM Eastern Daylight Time			08/06/2018 05:07:28 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	MedMutual.com/medicare	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	2	2019	Ohio Regions	Region 2	2	1918	2			2						medmutual.com/medicare	MedMutual.com/medicare	MedMutual.com/medicare	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	801	0	1	01	01	H6723_801_0	2	1				05/25/2018	2019.01	05/25/2018 12:48:04 PM Eastern Daylight Time					06/02/2018 09:08:43 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage EGWP (Calendar Year) (HMO)	01	01		1			H6723	801	0	2019	Ohio Regions		1	5900	2			2						medmutual.com/medicare	Medmutual.com/medicare	Medmutual.com/medicare	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1					1				
H6723	802	0	1	01	01	H6723_802_0	2	1				05/25/2018	2019.01	05/25/2018 12:48:17 PM Eastern Daylight Time					06/02/2018 09:08:43 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (Non-Calendar Year) (HMO)	01	01		1			H6723	802	0	2019	Ohio Regions		1	50	2			2						medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1					1				
H6723	803	0	1	01	01	H6723_803_0	2	1				05/25/2018	2019.01	05/25/2018 12:48:32 PM Eastern Daylight Time					06/02/2018 09:08:43 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (MA-Only) (HMO)	01	01		1			H6723	803	0	2019	Ohio Regions		1	50	2			2						medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1					1				
H6743	001	0	1	04	01	H6743_001_0	11	1				07/26/2018	2019.01	07/26/2018 04:44:16 PM Pacific Daylight Time	08/02/2018 08:53:26 AM Pacific Daylight Time	08/01/2018 12:24:05 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Basin) (PPO)	01	04		1			H6743	001	0	2019	Klamath County		2	24087	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	002	0	1	04	01	H6743_002_0	9	1				06/02/2018	2019.01	06/02/2018 05:42:17 PM Pacific Daylight Time	06/04/2018 06:19:45 PM Pacific Daylight Time				06/04/2018 07:47:09 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver (PPO)	01	04		1			H6743	002	0	2019	Douglas and Klamath Counties		2	2864	2			2						www.atriohp.com	www.atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2						2			
H6743	003	0	1	04	01	H6743_003_0	11	1				06/02/2018	2019.01	06/02/2018 05:37:04 PM Pacific Daylight Time	08/02/2018 08:55:56 AM Pacific Daylight Time	08/01/2018 12:24:51 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (PPO)	01	04		1			H6743	003	0	2019	Douglas and Klamath Counties		2	15559	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	004	0	1	04	01	H6743_004_0	12	1				06/04/2018	2019.01	06/04/2018 03:41:40 PM Pacific Daylight Time	08/02/2018 09:19:10 AM Pacific Daylight Time	08/01/2018 12:25:41 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Gold Rx (PPO)	01	04		1			H6743	004	0	2019	Douglas and Klamath Counties		2	14309	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	006	0	1	04	01	H6743_006_0	9	1				06/02/2018	2019.01	06/02/2018 05:42:23 PM Pacific Daylight Time	06/04/2018 06:23:21 PM Pacific Daylight Time				06/04/2018 07:47:09 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze (PPO)	01	04		1			H6743	006	0	2019	Douglas and Klamath Counties		2	5768	2			2						www.atriohp.com	www.atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2						2			
H6743	007	0	1	04	01	H6743_007_0	11	1				06/02/2018	2019.01	06/02/2018 05:39:41 PM Pacific Daylight Time	08/02/2018 09:03:24 AM Pacific Daylight Time	08/01/2018 12:26:28 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Umpqua) (PPO)	01	04		1			H6743	007	0	2019	Douglas County		2	44008	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	016	0	1	04	01	H6743_016_0	11	1				06/02/2018	2019.01	06/02/2018 05:40:15 PM Pacific Daylight Time	08/02/2018 09:04:43 AM Pacific Daylight Time	08/01/2018 12:27:14 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (Rogue) (PPO)	01	04		1			H6743	016	0	2019	Josephine and Jackson Counties		2	6549	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	018	1	1	04	01	H6743_018_1	11	1				07/31/2018	2019.01	07/31/2018 11:02:10 AM Pacific Daylight Time	08/02/2018 09:06:03 AM Pacific Daylight Time	08/01/2018 12:27:52 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Rogue) (PPO)	01	04		1			H6743	018	1	2019	Jackson and Josephine Counties	Jackson County	2	12616	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	018	3	1	04	01	H6743_018_3	11	1				06/02/2018	2019.01	06/02/2018 05:41:02 PM Pacific Daylight Time	08/02/2018 09:07:22 AM Pacific Daylight Time	08/01/2018 12:28:35 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Rogue) (PPO)	01	04		1			H6743	018	3	2019	Jackson and Josephine Counties	Josephine County	2	12616	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6750	001	0	1	01	01	H6750_001_0	5	1				07/26/2018	2019.01	07/26/2018 09:40:31 AM Eastern Daylight Time	08/06/2018 02:35:06 PM Eastern Daylight Time	08/02/2018 12:08:58 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	001	0	2019	New Hampshire		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	002	0	1	01	01	H6750_002_0	5	1				08/08/2018	2019.01	08/08/2018 12:55:26 AM Eastern Daylight Time	08/06/2018 02:37:48 PM Eastern Daylight Time	08/02/2018 12:10:28 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	002	0	2019	New Hampshire		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	005	0	1	01	01	H6750_005_0	5	1				08/08/2018	2019.01	08/08/2018 12:57:09 AM Eastern Daylight Time	08/06/2018 02:43:24 PM Eastern Daylight Time	08/02/2018 12:12:02 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Basic Rx (HMO)	01	01		1			H6750	005	0	2019	New Hampshire		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	006	0	1	01	01	H6750_006_0	5	1				08/08/2018	2019.01	08/08/2018 12:59:10 AM Eastern Daylight Time	08/06/2018 02:55:18 PM Eastern Daylight Time	08/02/2018 12:13:38 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Basic Rx (HMO)	01	01		1			H6750	006	0	2019	Barnstable County MA		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	007	0	1	01	01	H6750_007_0	5	1				07/17/2018	2019.01	07/17/2018 01:29:53 AM Eastern Daylight Time	08/06/2018 02:52:50 PM Eastern Daylight Time	08/02/2018 12:16:18 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	007	0	2019	Barnstable County MA		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	008	0	1	01	01	H6750_008_0	5	1				07/17/2018	2019.01	07/17/2018 01:30:53 AM Eastern Daylight Time	08/06/2018 02:49:50 PM Eastern Daylight Time	08/02/2018 12:18:06 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	008	0	2019	Barnstable County MA		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	009	0	1	01	01	H6750_009_0	5	1				08/08/2018	2019.01	08/08/2018 01:13:59 AM Eastern Daylight Time	08/06/2018 03:39:34 PM Eastern Daylight Time	08/02/2018 12:19:28 PM Eastern Daylight Time			08/08/2018 01:23:35 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Gain Rx (HMO)	01	01		1			H6750	009	0	2019	New Hampshire		2		2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	801	0	1	01	01	H6750_801_0	2	1				07/17/2018	2019.01	07/17/2018 01:46:51 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	801	0	2019	New Hampshire & Massachusetts		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	802	0	1	01	01	H6750_802_0	2	1				07/17/2018	2019.01	07/17/2018 01:47:05 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	802	0	2019	New Hampshire & Massachusetts		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	803	0	1	01	01	H6750_803_0	2	1				07/17/2018	2019.01	07/17/2018 01:47:21 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	803	0	2019	New Hampshire & Massachusetts		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	804	0	1	01	01	H6750_804_0	2	1				07/17/2018	2019.01	07/17/2018 01:47:42 AM Eastern Daylight Time					07/20/2018 01:31:12 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	804	0	2019	New Hampshire & Massachusetts		1	1200	2			2						www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6776	001	0	1	01	01	H6776_001_0	6	1		1		08/09/2018	2019.01	08/09/2018 02:29:35 PM Eastern Daylight Time	08/03/2018 12:05:48 PM Eastern Daylight Time	08/01/2018 09:04:14 AM Eastern Daylight Time			08/09/2018 02:53:31 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring Health Plans	riverspringstar.org	RiverSpring Star (HMO SNP)	01	01		1			H6776	001	0	2019	Counties: Brx, Ki, Na, NY, Qu, Ri, Wes		2	5772	2			1	1	3				riverspringstar.org	riverspringstar.org	riverspringstar.org	(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(855)898-1482		(855)898-1482		(855)898-1482		(855)898-1482		(711)-		(711)-		(711)-		(711)-		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					1					1	2			
H6776	002	0	1	01	01	H6776_002_0	6	1	2	1		08/09/2018	2019.01	08/09/2018 02:28:53 PM Eastern Daylight Time	08/01/2018 09:27:11 AM Eastern Daylight Time	08/01/2018 09:05:49 AM Eastern Daylight Time			08/09/2018 02:53:31 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring Health Plans	riverspringMAP.org	RiverSpring MAP (HMO SNP)	01	01		1			H6776	002	0	2019	Counties: Brx, Ki, Na, NY, Qu, Ri, Wes		2	1170	2			1	3		2		1	riverspringMAP.org	riverspringMAP.org	riverspringMAP.org	(800)362-2266		(800)362-2266		(800)362-2266		(800)362-2266		(855)898-1482		(855)898-1482		(855)898-1482		(855)898-1482		(711)-		(711)-		(711)-		(711)-		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					1					1	2			
H6786	002	0	1	04	01	H6786_002_0	6	1				07/27/2018	2019.01	07/27/2018 02:04:43 PM Eastern Daylight Time	08/06/2018 01:35:02 AM Eastern Daylight Time	08/01/2018 08:26:01 PM Eastern Daylight Time			08/06/2018 06:18:09 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H6786	002	0	2019	Androscoggin and Cumberland Counties		2	1090	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1785		(855)304-1785		(800)797-6458		(800)797-6458		(855)304-1785		(855)304-1785		(844)373-7114		(844)373-7114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6786	804	0	1	04	01	H6786_804_0	2	1				06/19/2018	2019.01	06/19/2018 01:46:43 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/me/medicare	Anthem MediBlue Preferred (PPO)	01	04		1			H6786	804	0	2019	National		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H6787	001	0	1	20	08	H6787_001_0	1	1				05/30/2018	2019.01	05/30/2018 03:16:50 PM Eastern Daylight Time		05/30/2018 03:12:23 PM Eastern Daylight Time			05/30/2018 03:20:12 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	Senior Community Care of Michigan	http://seniorcommunitycaremi.org	VOANS Senior Community Care of Michigan (PACE)	08	20		1			H6787	001	0	2019	Ingham, Eaton, and Clinton Counties		2		2			2						http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org										(517)319-0700		(517)319-0700		(517)319-0700		(517)319-0700										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000																
H6787	002	0	1	20	08	H6787_002_0	1	1				05/30/2018	2019.01	05/30/2018 03:17:34 PM Eastern Daylight Time		05/30/2018 03:13:01 PM Eastern Daylight Time			05/30/2018 03:20:12 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	Senior Community Care of Michigan	http://seniorcommunitycaremi.org	VOANS Senior Community Care of Michigan (PACE)	08	20		1			H6787	002	0	2019	Eaton, Ingham and Clinton County		2		2			2						http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org										(517)319-0700		(517)319-0700		(517)319-0700		(517)319-0700										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000																
H6815	003	1	1	01	01	H6815_003_1	3	1				08/02/2018	2019.01	08/02/2018 11:37:18 AM US Mountain Standard Time	08/03/2018 06:03:32 PM Pacific Daylight Time	08/03/2018 06:03:53 PM Pacific Daylight Time			08/03/2018 06:39:43 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Ruby (HMO)	01	01		1			H6815	003	1	2019	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM	Clackamas, Multnomah, Washington OR	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	003	2	1	01	01	H6815_003_2	3	1				08/02/2018	2019.01	08/02/2018 09:01:56 AM US Mountain Standard Time	08/03/2018 06:04:28 PM Pacific Daylight Time	08/03/2018 06:04:49 PM Pacific Daylight Time			08/03/2018 06:39:43 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Ruby (HMO)	01	01		1			H6815	003	2	2019	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM	OR Counties BE, LN, MN, PK, YM	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	003	3	1	01	01	H6815_003_3	4	1				08/02/2018	2019.01	08/02/2018 09:03:12 AM US Mountain Standard Time	08/03/2018 06:06:03 PM Pacific Daylight Time	08/03/2018 06:06:22 PM Pacific Daylight Time			08/03/2018 06:39:43 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Ruby (HMO)	01	01		1			H6815	003	3	2019	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM	Lane County	2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	005	0	1	01	01	H6815_005_0	6	1				08/03/2018	2019.01	08/03/2018 04:06:15 PM Pacific Daylight Time	08/05/2018 05:33:58 PM Pacific Daylight Time	08/03/2018 06:07:04 PM Pacific Daylight Time			08/07/2018 02:08:19 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Ruby (HMO)	01	01		1			H6815	005	0	2019	Douglas, Jackson, Josephine		2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	006	0	1	01	01	H6815_006_0	3	1				07/18/2018	2019.01	07/18/2018 11:11:09 AM US Mountain Standard Time	08/03/2018 06:07:57 PM Pacific Daylight Time	08/03/2018 06:08:17 PM Pacific Daylight Time			08/03/2018 06:39:43 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Ruby (HMO)	01	01		1			H6815	006	0	2019	Coos, Crooks, Descutes and Jefferson counties		2		2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	801	0	1	01	01	H6815_801_0	1	1				05/29/2018	2019.01	05/29/2018 05:30:44 PM Pacific Daylight Time					06/04/2018 04:41:55 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	801	0	2019	Oregon and California		1	220536	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6815	802	0	1	01	01	H6815_802_0	1	1				05/29/2018	2019.01	05/29/2018 05:30:38 PM Pacific Daylight Time					06/04/2018 04:41:55 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	802	0	2019	Oregon and California		1	54326	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6815	803	0	1	01	01	H6815_803_0	1	1				05/29/2018	2019.01	05/29/2018 05:30:49 PM Pacific Daylight Time					06/04/2018 04:41:55 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	803	0	2019	Oregon and California		1	20253	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6821	001	0	1	01	01	H6821_001_0	7	1				08/02/2018	2019.01	08/02/2018 03:20:40 PM Central Daylight Time	08/03/2018 09:09:04 AM Central Daylight Time	08/03/2018 09:11:07 AM Central Daylight Time			08/03/2018 11:26:45 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage Company	www.mutualofomaha.com	Mutual of Omaha CareAdvantage Complete (HMO)	01	01		1			H6821	001	0	2019	Bexar county		2	49145	2			2						www.mutualofomaha.com	www.mutualofomaha.com		(866)488-0249		(866)488-0249		(877)603-0787		(877)603-0787		(866)488-0249		(866)488-0249		(877)603-0787		(877)603-0787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	002	0	1	01	01	H6821_002_0	8	1				08/02/2018	2019.01	08/02/2018 03:21:16 PM Central Daylight Time	08/03/2018 09:17:24 AM Central Daylight Time	08/03/2018 09:20:00 AM Central Daylight Time			08/03/2018 11:26:45 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage Company	www.mutualofomaha.com	Mutual of Omaha CareAdvantage Plus (HMO)	01	01		1			H6821	002	0	2019	Cincinnati Metro area		2	8427	2			2						www.mutualofomaha.com	www.mutualofomaha.com		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	003	0	1	01	01	H6821_003_0	7	1				08/02/2018	2019.01	08/02/2018 03:21:51 PM Central Daylight Time	08/03/2018 09:28:37 AM Central Daylight Time	08/03/2018 09:31:31 AM Central Daylight Time			08/03/2018 11:26:45 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage Company	www.mutualofomaha.com	Mutual of Omaha CareAdvantage Complete (HMO)	01	01		1			H6821	003	0	2019	Ohio- Butler, Clermont, Hamilton & Warren counties		2	36870	2			2						www.mutualofomaha.com	www.mutualofomaha.com		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	004	0	1	01	01	H6821_004_0	7	1				08/02/2018	2019.01	08/02/2018 03:22:16 PM Central Daylight Time	08/03/2018 09:36:18 AM Central Daylight Time	08/03/2018 09:38:31 AM Central Daylight Time			08/03/2018 11:26:45 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage Company	www.mutualofomaha.com	Mutual of Omaha CareAdvantage Complete (HMO)	01	01		1			H6821	004	0	2019	Kentucky - Boone, Campbell and Kenton counties		2	7374	2			2						www.mutualofomaha.com	www.mutualofomaha.com		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	801	0	1	01	01	H6821_801_0	2	1				05/24/2018	2019.01	05/24/2018 01:40:22 PM Central Daylight Time					06/01/2018 10:13:18 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage Company	www.mutualofomaha.com	MAPD EGWP Calendar year (HMO)	01	01		1			H6821	801	0	2019	Cincinnati Metro area and Bexar County, Texas		1	300	2			2						www.mutualofomaha.com	www.mutualofomaha.com		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;	1					1				
H6821	802	0	1	01	01	H6821_802_0	2	1				05/24/2018	2019.01	05/24/2018 01:40:32 PM Central Daylight Time					06/01/2018 10:13:18 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage Company	www.mutualofomaha.com	MAPD EGWP non Calendar year (HMO)	01	01		1			H6821	802	0	2019	Cincinnati Metro area and Bexar County, Texas		1	300	2			2						www.mutualofomaha.com	www.mutualofomaha.com		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	3-1;3-2;3-3;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;	1					1				
H6846	001	0	1	20	08	H6846_001_0	1	1				05/23/2018	2019.01	05/23/2018 01:33:30 PM Eastern Daylight Time		05/23/2018 02:51:37 PM Eastern Daylight Time			05/23/2018 05:12:21 PM Eastern Daylight Time	MISSION HOSPITAL, INC.	CarePartners PACE	http://www.carepartners.org/services_adult_pac.htm	Mission Hospital, Inc. (PACE)	08	20		1			H6846	001	0	2019	Buncombe and Henderson Counties		2		2			2						http://www.missionpardeehealthcampus.org/services/	www.carepartners.org										(800)000-0000		(828)213-8442		(800)000-0000		(828)213-8442										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6846	002	0	1	20	08	H6846_002_0	1	1				05/23/2018	2019.01	05/23/2018 01:33:39 PM Eastern Daylight Time		05/23/2018 02:51:25 PM Eastern Daylight Time			05/23/2018 05:12:21 PM Eastern Daylight Time	MISSION HOSPITAL, INC.	CarePartners PACE	http://www.carepartners.org/services_adult_pac.htm	Mission Hospital, Inc. (PACE)	08	20		1			H6846	002	0	2019	Buncombe and Henderson Counties		2		2			2						http://www.missionpardeehealthcampus.org/services/	www.carepartners.org										(800)000-0000		(828)213-8442		(800)000-0000		(828)213-8442										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6870	001	0	1	48	05	H6870_001_0	3	1				08/09/2018	2019.01	08/09/2018 03:26:55 PM Eastern Daylight Time					08/09/2018 03:07:43 PM Pacific Daylight Time	SUPERIOR HEALTH PLAN, INC.	Superior HealthPlan	mmp.superiorhealthplan.com	Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan)	05	48		1			H6870	001	0	2019	Bexar, Dallas and Hidalgo Counties		2	90000	2			2						mmp.superiorhealthplan.com/2017/benefits/find-a-doctor-or-pharmacy	mmp.superiorhealthplan.com/2017/prescription-drug-part-d/formulary	mmp.superiorhealthplan.com/2017/benefits/find-a-doctor-or-pharmacy	(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6887	001	0	1	20	08	H6887_001_0	1	1				05/30/2018	2019.01	05/30/2018 10:09:05 AM Eastern Daylight Time		05/30/2018 09:05:18 AM Eastern Daylight Time			05/30/2018 10:22:02 AM Eastern Daylight Time	INSPIRA HEALTH NETWORK LIFE, INC.	Inspira Health Network LIFE	http://www.inspirahealthnetwork.org/life-center	Inspira Health Network LIFE (PACE)	08	20		1			H6887	001	0	2019	Inspira Health Network LIFE		2		2			2						http://www.inspirahealthnetwork.org/	http://www.inspirahealthnetwork.org/										(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516										(855)295-5433		(856)632-4516		(855)295-5433		(856)632-4516																
H6887	002	0	1	20	08	H6887_002_0	1	1				05/30/2018	2019.01	05/30/2018 10:09:49 AM Eastern Daylight Time		05/30/2018 09:05:21 AM Eastern Daylight Time			05/30/2018 10:22:02 AM Eastern Daylight Time	INSPIRA HEALTH NETWORK LIFE, INC.	Inspira Health Network LIFE	http://www.inspirahealthnetwork.org/life-center	Inspira Health Network LIFE (PACE)	08	20		1			H6887	002	0	2019	Inspira Health Network LIFE		2		2			2						http://www.inspirahealthnetwork.org/	http://www.inspirahealthnetwork.org/										(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516										(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516																
H6941	001	0	1	20	08	H6941_001_0	4	1				05/23/2018	2019.01	05/23/2018 02:14:19 PM Central Daylight Time		05/29/2018 03:18:34 PM Central Daylight Time			05/29/2018 03:20:23 PM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	www.lifepace.org	LIFE PACE Dual Eligible 001 (PACE)	08	20		1			H6941	001	0	2019	Tulsa County		2		2			2						www.carekinesis.com	www.lifepace.org										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969																
H6941	002	0	1	20	08	H6941_002_0	1	1				05/23/2018	2019.01	05/23/2018 02:15:19 PM Central Daylight Time		05/23/2018 01:47:41 PM Central Daylight Time			05/23/2018 02:28:51 PM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	www.lifepace.org	LIFE PACE Medicare Only 002 (PACE)	08	20		1			H6941	002	0	2019	Tulsa County		2		2			2						www.carekinesis.com	www.lifepace.org										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969																
H6975	001	0	1	01	01	H6975_001_0	4	1				08/03/2018	2019.01	08/03/2018 12:35:09 PM Eastern Daylight Time	08/06/2018 05:58:59 PM Eastern Daylight Time	08/01/2018 02:48:21 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H6975	001	0	2019	Selected Counties in AL		2	128	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fab_search	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6988	001	0	1	01	01	H6988_001_0	7	1				08/07/2018	2019.01	08/07/2018 11:13:00 AM Eastern Daylight Time	08/01/2018 02:08:46 PM Eastern Daylight Time	07/31/2018 05:11:40 PM Eastern Daylight Time			08/07/2018 11:17:43 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Medicare Advantage Care (HMO)	01	01		1			H6988	001	0	2019	NYC Metro Area, ERIE, NASS, NIAG, ROCK Counties		2	287	2			2						www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	002	0	1	01	01	H6988_002_0	7	1	2	1		06/01/2018	2019.01	06/01/2018 04:40:48 PM Eastern Daylight Time	08/01/2018 02:07:26 PM Eastern Daylight Time	07/31/2018 05:12:56 PM Eastern Daylight Time			08/07/2018 11:17:43 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Dual Coverage Care (HMO SNP)	01	01		1			H6988	002	0	2019	Kings,Queens,Bronx,Manhattan and Richmond Counties		2		2			1	3		2		2	www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	003	0	1	01	01	H6988_003_0	7	1		1		06/01/2018	2019.01	06/01/2018 11:58:26 AM Eastern Daylight Time	08/06/2018 02:59:48 PM Eastern Daylight Time	08/06/2018 02:59:48 PM Eastern Daylight Time			08/07/2018 11:17:43 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Nursing Home Care (HMO SNP)	01	01		1			H6988	003	0	2019	NYC Metro Area, Rockland, Erie, Niagara Counties		2	287	2			1	1	1				www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	004	0	1	01	01	H6988_004_0	7	1	2	1		05/30/2018	2019.01	05/30/2018 12:35:17 PM Eastern Daylight Time	08/01/2018 02:05:36 PM Eastern Daylight Time	07/31/2018 05:19:12 PM Eastern Daylight Time			08/07/2018 11:17:43 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Medicaid Advantage Plus (HMO SNP)	01	01		1			H6988	004	0	2019	NYC Metro Area, NASS, ROCK County		2		2			1	3		1		2	www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	801	0	1	01	01	H6988_801_0	4	1				06/01/2018	2019.01	06/01/2018 10:35:41 AM Eastern Daylight Time					06/04/2018 11:09:23 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Employer Groups (HMO)	01	01		1			H6988	801	0	2019	NYC Metro Area, ERIE, NASS, NIAG, ROCK Counties		1	63	2			2						www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		1	1	1a;1b;2;3-1;5;6;7b;7c;7f;7g;7i;9a1;9a2;9b;9c;11a;11b;12;14d;15;	1	7b;7f;7g;7h;	1					1				
H7003	001	0	1	20	08	H7003_001_0	1	1				05/31/2018	2019.01	05/31/2018 10:28:28 AM Central Daylight Time		05/31/2018 10:17:36 AM Central Daylight Time			05/31/2018 11:07:30 AM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	Immanuel.com	PACE Nebraska (PACE)	08	20		1			H7003	001	0	2019	Select Zip Codes in DO, SA, and W, DG, C, and SU		2		2			2						http://www.immanuelpathways.org/	www.immanuelpathways,org												(402)991-0330				(402)991-0330												(402)991-0330				(402)991-0330																
H7003	002	0	1	20	08	H7003_002_0	1	1				05/31/2018	2019.01	05/31/2018 10:28:40 AM Central Daylight Time		05/31/2018 10:17:38 AM Central Daylight Time			05/31/2018 11:07:30 AM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	immanuelpathways.org	PACE Nebraska (PACE)	08	20		1			H7003	002	0	2019	Select Zip Codes in DO, SA, and W, DG, C, and SU		2		2			2						http://www.immanuelpathways.org/	www.immanuelpathways,org												(402)991-0330				(402)991-0330												(402)991-0330				(402)991-0330																
H7006	001	0	1	04	01	H7006_001_0	12	1				07/10/2018	2019.01	07/10/2018 02:22:37 PM Pacific Daylight Time	08/02/2018 09:08:41 AM Pacific Daylight Time	08/01/2018 12:29:29 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Gold Rx (Willamette) (PPO)	01	04		1			H7006	001	0	2019	Marion and Polk Counties		2	17303	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H7006	003	0	1	04	01	H7006_003_0	12	1				06/02/2018	2019.01	06/02/2018 05:41:54 PM Pacific Daylight Time	08/02/2018 09:10:01 AM Pacific Daylight Time	08/01/2018 12:30:12 PM Pacific Daylight Time			08/07/2018 04:43:07 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (Willamette) (PPO)	01	04		1			H7006	003	0	2019	Marion and Polk Counties		2	27303	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H7020	004	0	1	01	01	H7020_004_0	4	1				08/01/2018	2019.01	08/01/2018 05:11:31 PM Central Daylight Time	08/03/2018 05:14:22 PM Central Daylight Time	07/31/2018 08:50:37 PM Central Daylight Time			08/06/2018 11:56:06 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H7020	004	0	2019	Select South Carolina Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	005	0	1	01	01	H7020_005_0	4	1				06/01/2018	2019.01	06/01/2018 04:23:41 PM Central Daylight Time	07/16/2018 10:40:17 AM Central Daylight Time				07/19/2018 11:45:16 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H7020	005	0	2019	Select South Carolina Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7020	006	0	1	01	01	H7020_006_0	4	1				08/01/2018	2019.01	08/01/2018 05:11:53 PM Central Daylight Time	08/03/2018 05:14:45 PM Central Daylight Time	07/31/2018 08:53:58 PM Central Daylight Time			08/06/2018 11:56:06 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	01	01		1			H7020	006	0	2019	Select South Carolina Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	801	0	1	01	01	H7020_801_0	2	1				05/23/2018	2019.01	05/23/2018 12:36:57 PM Central Daylight Time					05/31/2018 03:46:13 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H7020	801	0	2019	South Carolina		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1					1				
H7020	807	0	1	02	01	H7020_807_0	2	1				05/23/2018	2019.01	05/23/2018 12:42:58 PM Central Daylight Time					05/31/2018 03:46:13 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H7020	807	0	2019	South Carolina		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	1	1a;3-1;3-2;3-3;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;12;14d;14e2;18a;	1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1				
H7114	001	0	1	20	08	H7114_001_0	2	1				06/04/2018	2019.01	06/04/2018 09:11:23 AM Central Daylight Time		07/27/2018 11:35:13 AM Central Daylight Time			07/27/2018 11:36:32 AM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valirpace.org	Dual (PACE)	08	20		1			H7114	001	0	2019	Oklahoma County		2		2			2						www.valir.com	www.valir.com										(888)898-2080		(405)609-3688		(888)898-8020		(405)609-3688										(711)-		(711)-		(711)-		(711)-																
H7114	002	0	1	20	08	H7114_002_0	2	1				06/04/2018	2019.01	06/04/2018 09:11:53 AM Central Daylight Time		07/27/2018 11:35:02 AM Central Daylight Time			07/27/2018 11:36:32 AM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valirpace.org	Medicare Only (PACE)	08	20		1			H7114	002	0	2019	Oklahoma County		2		2			2						www.valir.com	www.valir.com										(888)898-2080		(405)609-3688		(888)898-8020		(405)609-3688										(711)-		(711)-		(711)-		(711)-																
H7115	001	0	1	01	01	H7115_001_0	7	1				06/28/2018	2019.01	06/28/2018 06:07:53 PM Central Daylight Time	08/02/2018 11:41:43 AM Central Daylight Time	08/02/2018 11:36:17 AM Central Daylight Time			08/07/2018 09:23:10 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	001	0	2019	Texas Counties - Harris, Montgomery, Fort Bend		2	84000	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	805	0	1	01	01	H7115_805_0	1	1				06/01/2018	2019.01	06/01/2018 04:31:22 PM Central Daylight Time					06/04/2018 12:43:46 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	805	0	2019	Texas Counties - Harris, Montgomery, Fort Bend		1	14400	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	806	0	1	01	01	H7115_806_0	1	1				06/01/2018	2019.01	06/01/2018 04:31:35 PM Central Daylight Time					06/04/2018 12:43:46 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	806	0	2019	Texas Counties - Harris, Montgomery, Fort Bend		1	14400	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	807	0	1	01	01	H7115_807_0	1	1				06/01/2018	2019.01	06/01/2018 04:31:45 PM Central Daylight Time					06/04/2018 12:43:46 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	807	0	2019	Texas Counties - Harris, Montgomery, Fort Bend		1	14400	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7119	001	0	1	01	01	H7119_001_0	5	1		1		08/03/2018	2019.01	08/03/2018 11:06:48 AM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time			08/07/2018 03:07:55 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF OHIO	Provider Partners Ohio Advantage Plan	pphealthplan.com	Provider Partners Health Plan of Ohio (HMO SNP)	01	01		1			H7119	001	0	2019	Central, Southern, Northeastern		2	3510	2			1	1	1				pphealthplan.com	pphealthplan.com	pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H7149	001	0	1	01	01	H7149_001_0	3	1				08/02/2018	2019.01	08/02/2018 03:36:00 PM Eastern Daylight Time	08/01/2018 04:19:40 PM Eastern Daylight Time	07/31/2018 06:33:59 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Advantra Silver (HMO)	01	01		1			H7149	001	0	2019	Partial State of Nebraska		2	63456	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	004	0	1	01	01	H7149_004_0	2	1				08/02/2018	2019.01	08/02/2018 03:36:06 PM Eastern Daylight Time	08/01/2018 04:21:15 PM Eastern Daylight Time	07/31/2018 06:34:39 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Total Care (HMO)	01	01		1			H7149	004	0	2019	Douglas and Sarpy Counties Nebraska		2	13248	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	801	0	1	01	01	H7149_801_0	3	1				06/04/2018	2019.01	06/04/2018 11:50:39 AM Eastern Daylight Time					06/04/2018 12:03:39 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/NoRx/Cyear (HMO)	01	01		1			H7149	801	0	2019	Partial State of Nebraska		1	120	2			2						PharmacyLocator.coventry-medicare.com	IANEFormulary.coventry-medicare.com	ProviderDirectory.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H7149	802	0	1	01	01	H7149_802_0	3	1				06/04/2018	2019.01	06/04/2018 11:50:25 AM Eastern Daylight Time					06/04/2018 12:03:39 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/Rx/Cyear (HMO)	01	01		1			H7149	802	0	2019	Partial State of Nebraska		1	120	2			2						PharmacyLocator.coventry-medicare.com	IANEFormulary.coventry-medicare.com	ProviderDirectory.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(844)741-8423		(844)741-8423		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H7165	001	0	1	01	01	H7165_001_0	7	1				07/02/2018	2019.01	07/02/2018 12:17:31 PM Eastern Daylight Time	08/02/2018 02:02:58 PM Eastern Daylight Time	08/01/2018 02:06:32 PM Eastern Daylight Time			08/02/2018 06:40:59 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	BlueCross Secure (HMO)	01	01		1			H7165	001	0	2019	Greenville County		2	6000	2			2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7165	002	0	1	01	01	H7165_002_0	7	1				07/02/2018	2019.01	07/02/2018 12:19:39 PM Eastern Daylight Time	08/02/2018 02:03:47 PM Eastern Daylight Time	08/01/2018 02:07:25 PM Eastern Daylight Time			08/02/2018 06:40:59 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	BlueCross Secure (HMO)	01	01		1			H7165	002	0	2019	Richland County		2	6000	2			2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7165	801	0	1	01	01	H7165_801_0	1	1				05/07/2018	2019.01	05/07/2018 01:46:16 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MAPD Calendar Year Group (HMO)	01	01		1			H7165	801	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H7165	802	0	1	01	01	H7165_802_0	1	1				05/07/2018	2019.01	05/07/2018 01:56:18 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MAPD Non-calendar Year Group (HMO)	01	01		1			H7165	802	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H7165	803	0	1	01	01	H7165_803_0	1	1				05/07/2018	2019.01	05/07/2018 01:58:43 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MA Only Calendar Year Group (HMO)	01	01		1			H7165	803	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H7165	804	0	1	01	01	H7165_804_0	1	1				05/07/2018	2019.01	05/07/2018 02:00:34 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MA Only Non-calendar Year Group (HMO)	01	01		1			H7165	804	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H7172	001	0	1	48	05	H7172_001_0	7	1				08/24/2018	2019.01	08/24/2018 01:46:20 PM Central Daylight Time					08/24/2018 01:55:51 PM Central Daylight Time	AETNA BETTER HEALTH, INC. (OH)	Aetna Better Health of Ohio, MyCare Ohio	www.aetnabetterhealth.com/ohio	Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H7172	001	0	2019	Ohio		2	292696	2			2						www.aetnabetterhealth.com/ohio	www.aetnabetterhealth.com/ohio	www.aetnabetterhealth.com/ohio	(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7173	001	0	1	01	01	H7173_001_0	7	1	2	1		08/03/2018	2019.01	08/03/2018 02:38:54 PM Eastern Daylight Time	08/03/2018 07:23:34 PM Eastern Daylight Time	08/03/2018 07:52:16 PM Eastern Daylight Time			08/06/2018 09:39:52 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Allwell	allwell.pshpgeorgia.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H7173	001	0	2019	Metro Atl, N. GA, Muscogee, Chatt, Harris, Heard		2		2			1	3		2		2	allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(877)725-7748		(877)725-7748		(877)826-3693		(877)826-3693		(877)725-7748		(877)725-7748		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	002	0	1	01	01	H7173_002_0	7	1				08/02/2018	2019.01	08/02/2018 10:57:18 AM Eastern Daylight Time	08/03/2018 07:23:34 PM Eastern Daylight Time	08/03/2018 07:52:16 PM Eastern Daylight Time			08/06/2018 09:39:52 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Allwell	allwell.pshpgeorgia.com	Allwell Medicare (HMO)	01	01		1			H7173	002	0	2019	Fulton, DeKalb, Gwinnett, Clayton, Fayette		2		2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	003	0	1	01	01	H7173_003_0	7	1				08/02/2018	2019.01	08/02/2018 10:57:38 AM Eastern Daylight Time	08/03/2018 07:23:34 PM Eastern Daylight Time	08/03/2018 07:52:16 PM Eastern Daylight Time			08/06/2018 09:39:52 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Allwell	allwell.pshpgeorgia.com	Allwell Medicare (HMO)	01	01		1			H7173	003	0	2019	Chatt, Harris, Muscogee, Greene, Morgan, Oconee		2		2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	007	0	1	01	01	H7173_007_0	7	1				08/02/2018	2019.01	08/02/2018 10:58:33 AM Eastern Daylight Time	08/03/2018 07:23:34 PM Eastern Daylight Time	08/03/2018 07:52:16 PM Eastern Daylight Time			08/06/2018 09:39:52 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Allwell	allwell.pshpgeorgia.com	Allwell Medicare Premier (HMO)	01	01		1			H7173	007	0	2019	Dekalb, Fulton, Gwinnett		2		2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7195	001	0	1	20	08	H7195_001_0	1	1				05/22/2018	2019.01	05/22/2018 02:07:39 PM Central Daylight Time		05/22/2018 01:55:50 PM Central Daylight Time			05/22/2018 02:23:35 PM Central Daylight Time	NORTHLAND PACE PROGRAM	Northland PACE Senior Care Services	http://www.northlandpace.com	Northland PACE - Dual (PACE)	08	20		1			H7195	001	0	2019	Burleigh, Morton, Stark and Ward Counties		2		2			2						http://www.pharmastarpbm.com/	n/a										(888)883-8959		(701)751-3050		(888)883-8959		(701)751-3050										(888)838-8959		(701)751-3050		(888)838-8959		(701)751-3050																
H7195	002	0	1	20	08	H7195_002_0	1	1				05/22/2018	2019.01	05/22/2018 02:08:04 PM Central Daylight Time		05/22/2018 01:55:51 PM Central Daylight Time			05/22/2018 02:23:35 PM Central Daylight Time	NORTHLAND PACE PROGRAM	Northland PACE Senior Care Services	http://www.northlandpace.com	Northland PACE - Medicare Only (PACE)	08	20		1			H7195	002	0	2019	Burleigh, Morton, Stark and Ward Counties		2		2			2						http://www.pharmastarpbm.com/	n/a										(888)883-8959		(701)751-3050		(888)883-8959		(701)751-3050										(888)838-8959		(701)751-3050		(888)838-8959		(701)751-3050																
H7220	002	0	1	01	01	H7220_002_0	3	1			1	07/02/2018	2019.01	07/02/2018 04:07:18 PM Eastern Daylight Time	05/31/2018 10:06:25 AM Eastern Daylight Time				07/02/2018 04:10:39 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select (HMO)	01	01		1			H7220	002	0	2019	State of Indiana - 31 counties		2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2					2	2			
H7220	004	0	1	02	01	H7220_004_0	6	1			1	07/02/2018	2019.01	07/02/2018 04:08:42 PM Eastern Daylight Time	08/06/2018 09:20:09 AM Eastern Daylight Time	08/06/2018 09:20:09 AM Eastern Daylight Time			08/06/2018 10:59:41 AM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Choice (HMO-POS)	01	02		1			H7220	004	0	2019	State of Indiana - 25 counties		2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	009	1	1	01	01	H7220_009_1	4	1			1	07/02/2018	2019.01	07/02/2018 04:07:42 PM Eastern Daylight Time	08/06/2018 09:20:09 AM Eastern Daylight Time	08/06/2018 09:20:08 AM Eastern Daylight Time			08/06/2018 10:59:41 AM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	009	1	2019	Indianapolis Metro Area and Surrounding Counties	State of Indiana - 34 counties	2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	009	2	1	01	01	H7220_009_2	4	1			1	07/02/2018	2019.01	07/02/2018 04:08:01 PM Eastern Daylight Time	08/06/2018 09:20:08 AM Eastern Daylight Time	08/06/2018 09:20:08 AM Eastern Daylight Time			08/06/2018 10:59:41 AM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	009	2	2019	Indianapolis Metro Area and Surrounding Counties	Indianapolis Metro Area	2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	009	3	1	01	01	H7220_009_3	4	1			1	07/02/2018	2019.01	07/02/2018 04:08:22 PM Eastern Daylight Time	08/06/2018 09:20:08 AM Eastern Daylight Time	08/06/2018 09:20:08 AM Eastern Daylight Time			08/06/2018 10:59:41 AM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	009	3	2019	Indianapolis Metro Area and Surrounding Counties	Ft. Wayne Area	2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7245	001	0	1	01	01	H7245_001_0	11	1				08/06/2018	2019.01	08/06/2018 09:18:02 AM Pacific Daylight Time	08/02/2018 10:07:49 AM Pacific Daylight Time	07/31/2018 01:45:19 PM Pacific Daylight Time			08/06/2018 01:23:09 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage (HMO)	01	01		1			H7245	001	0	2019	King,Lew,Pie,Skag,Sno,Spo,Ste,Thu,Wha		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7245	002	0	1	01	01	H7245_002_0	12	1				08/06/2018	2019.01	08/06/2018 09:18:11 AM Pacific Daylight Time	08/02/2018 10:24:11 AM Pacific Daylight Time	07/31/2018 01:47:59 PM Pacific Daylight Time			08/06/2018 01:23:09 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Classic (HMO)	01	01		1			H7245	002	0	2019	King,Lew,Pie,Skag,Sno,Spo,Ste,Thu,Wha		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7245	003	0	1	01	01	H7245_003_0	12	1				08/06/2018	2019.01	08/06/2018 09:18:21 AM Pacific Daylight Time	08/03/2018 09:59:31 AM Pacific Daylight Time	08/02/2018 12:17:42 PM Pacific Daylight Time			08/06/2018 01:23:09 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Classic Plus (HMO)	01	01		1			H7245	003	0	2019	King,Lew,Pie,Skag,Sno,Spo,Ste,Thu,Wha		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7245	005	0	1	01	01	H7245_005_0	11	1				08/06/2018	2019.01	08/06/2018 09:19:49 AM Pacific Daylight Time	08/02/2018 03:58:49 PM Pacific Daylight Time	08/02/2018 12:20:16 PM Pacific Daylight Time			08/06/2018 01:23:09 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Total Health (HMO)	01	01		1			H7245	005	0	2019	King,Lew,Pie,Skag,Sno,Spo,Ste,Thu,Wha		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7245	006	0	1	01	01	H7245_006_0	11	1				08/06/2018	2019.01	08/06/2018 09:20:09 AM Pacific Daylight Time	08/02/2018 10:55:28 AM Pacific Daylight Time	07/31/2018 01:55:16 PM Pacific Daylight Time			08/06/2018 01:23:09 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Core (HMO)	01	01		1			H7245	006	0	2019	King,Lew,Pie,Skag,Sno,Spo,Ste,Thu,Wha		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7262	001	0	1	20	08	H7262_001_0	1	1				05/30/2018	2019.01	05/30/2018 07:12:47 AM Mountain Daylight Time		05/29/2018 02:31:54 PM Mountain Daylight Time			05/30/2018 07:44:28 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	08	20		1			H7262	001	0	2019	Boulder and Southwest Weld Counties		2		2			2						TBD	www.trucare.org												(303)665-0115				(303)665-0115												(800)659-2656				(800)659-2656																
H7262	002	0	1	20	08	H7262_002_0	1	1				05/30/2018	2019.01	05/30/2018 07:14:40 AM Mountain Daylight Time		05/29/2018 02:33:02 PM Mountain Daylight Time			05/30/2018 07:44:28 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	08	20		1			H7262	002	0	2019	Boulder and Southwest Weld Counties		2		2			2						TBD	www.trucare.org												(303)665-0115				(303)665-0115												(800)659-2656				(800)659-2656																
H7284	001	0	1	04	01	H7284_001_0	6	1				07/11/2018	2019.01	07/11/2018 11:16:51 AM Eastern Daylight Time	08/03/2018 11:52:37 AM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-001 (PPO)	01	04		1			H7284	001	0	2019	Lake, Marion, Seminole and Sumter counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	002	0	1	04	01	H7284_002_0	6	1				07/18/2018	2019.01	07/18/2018 04:03:28 PM Eastern Daylight Time	07/18/2018 02:10:16 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 01:50:44 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-002 (PPO)	01	04		1			H7284	002	0	2019	Charlotte, Collier and Lee counties		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	002	0	1	04	01	H7301_002_0	4	1				08/02/2018	2019.01	08/02/2018 03:36:17 PM Eastern Daylight Time	08/02/2018 02:23:46 PM Eastern Daylight Time	07/31/2018 06:35:21 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Advantra (PPO)	01	04		1			H7301	002	0	2019	Northern/Northwestern Illinois		2	122424	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	006	0	1	04	01	H7301_006_0	2	1				08/02/2018	2019.01	08/02/2018 03:36:25 PM Eastern Daylight Time	08/02/2018 02:24:24 PM Eastern Daylight Time	07/31/2018 06:36:01 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Advantra Value (PPO)	01	04		1			H7301	006	0	2019	Northern/Northwestern Illinois		2	43632	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	007	0	1	04	01	H7301_007_0	2	1				08/03/2018	2019.01	08/03/2018 04:33:47 PM Central Daylight Time	08/02/2018 01:38:30 PM Central Daylight Time	07/31/2018 10:35:14 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Advantra Value (PPO)	01	04		1			H7301	007	0	2019	Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	009	0	1	04	01	H7301_009_0	2	1				08/03/2018	2019.01	08/03/2018 04:34:57 PM Central Daylight Time	08/02/2018 01:39:36 PM Central Daylight Time	07/31/2018 10:36:06 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Advantra Complete (PPO)	01	04		1			H7301	009	0	2019	Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	801	0	1	04	01	H7301_801_0	3	1				06/04/2018	2019.01	06/04/2018 11:55:02 AM Eastern Daylight Time					06/04/2018 12:06:42 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care	www.chcillinoismedicare.com	Advantra MA Integrated Calendar (PPO)	01	04		1			H7301	801	0	2019	Central and Northern Illinois		1	120	2			2						http://pharmacylocator.coventry-medicare.com	http://www.formulary.coventry-medicare.com	https://coventry-medicare.com/findprovider	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7301	803	0	1	04	01	H7301_803_0	2	1				06/04/2018	2019.01	06/04/2018 11:54:57 AM Eastern Daylight Time					06/04/2018 12:06:42 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care	www.chcillinoismedicare.com	Advantra MA Only (PPO)	01	04		1			H7301	803	0	2019	Central and Northern Illinois		1	120	2			2						http://pharmacylocator.coventry-medicare.com	http://www.formulary.coventry-medicare.com	https://coventry-medicare.com/findprovider	(855)275-5888		(855)275-5888		(866)557-8753		(866)557-8753										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7317	001	0	1	01	01	H7317_001_0	7	1				08/06/2018	2019.01	08/06/2018 03:36:50 PM Hawaiian Standard Time	08/06/2018 08:27:07 AM Hawaiian Standard Time	08/01/2018 04:04:08 AM Hawaiian Standard Time			08/07/2018 10:59:43 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	Essential Advantage	www.hmsa.com/advantage	Essential Advantage (HMO)	01	01		1			H7317	001	0	2019	Honolulu County		2	4584	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7317	801	0	1	01	01	H7317_801_0	2	1				06/01/2018	2019.01	06/01/2018 04:17:43 PM Hawaiian Standard Time					06/01/2018 04:41:43 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	Essential Advantage	www.hmsa.com/advantage	Essential Advantage EGWP with Drug CY (HMO)	01	01		1			H7317	801	0	2019	Honolulu County		1	0	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;9a1;9b;9c;9d;12;14d;14e6;16b;17a;18a;	2					2				
H7326	001	0	1	04	01	H7326_001_0	4	1				08/03/2018	2019.01	08/03/2018 01:15:21 PM Eastern Daylight Time	08/06/2018 05:59:40 PM Eastern Daylight Time	08/01/2018 02:48:42 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	01	04		1			H7326	001	0	2019	Select Counties in SC		2	21486	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fap_search	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	002	0	1	04	01	H7326_002_0	4	1				08/03/2018	2019.01	08/03/2018 01:15:57 PM Eastern Daylight Time	08/06/2018 06:00:22 PM Eastern Daylight Time	08/01/2018 02:49:03 PM Eastern Daylight Time			08/07/2018 02:22:03 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	01	04		1			H7326	002	0	2019	Select Counties in SC		2	18493	2			2						www.WellCare.com/our_pharmacies/default	www.WellCare.com/medicare/medication_guide	www.wellcare.com/fap_search	(855)292-0237		(855)292-0237		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	001	0	1	04	01	H7404_001_0	4	1				07/12/2018	2019.01	07/12/2018 12:42:52 PM Central Daylight Time	08/03/2018 09:52:57 AM Central Daylight Time	07/31/2018 07:52:18 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Headwaters (PPO)	01	04		1			H7404	001	0	2019	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	002	0	1	04	01	H7404_002_0	4	1				07/12/2018	2019.01	07/12/2018 12:43:30 PM Central Daylight Time	08/03/2018 09:53:40 AM Central Daylight Time	07/31/2018 07:52:42 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Lakeshore (PPO)	01	04		1			H7404	002	0	2019	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	004	0	1	04	01	H7404_004_0	4	1				07/12/2018	2019.01	07/12/2018 04:36:47 PM Central Daylight Time	08/03/2018 09:54:21 AM Central Daylight Time	07/31/2018 07:53:04 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Sync (PPO)	01	04		1			H7404	004	0	2019	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	005	0	1	04	01	H7404_005_0	4	1				08/02/2018	2019.01	08/02/2018 03:55:54 PM Central Daylight Time	08/03/2018 09:55:07 AM Central Daylight Time	07/31/2018 07:53:28 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Headwaters (PPO)	01	04		1			H7404	005	0	2019	Carlton and St. Louis Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	006	0	1	04	01	H7404_006_0	4	1				07/12/2018	2019.01	07/12/2018 12:46:09 PM Central Daylight Time	08/03/2018 09:55:50 AM Central Daylight Time	07/31/2018 07:53:50 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Lakeshore (PPO)	01	04		1			H7404	006	0	2019	Carlton and St. Louis Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7419	001	0	1	48	05	H7419_001_0	5	1				09/20/2018	2019.01	09/20/2018 12:49:43 PM Eastern Daylight Time					09/20/2018 12:50:26 PM Eastern Daylight Time	TUFTS HEALTH PUBLIC PLANS, INC.	Tufts Health Plan	www.ChooseUnify.org	Tufts Health Unify (Medicare-Medicaid Plan)	05	48		1			H7419	001	0	2019	Middlesex*, Worcester and Suffolk counties		2	36000	2			2						www.TuftsHealthUnify.org	www.TuftsHealthUnify.org	www.TuftsHealthUnify.org	(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7445	004	0	1	01	01	H7445_004_0	3	1				05/29/2018	2019.01	05/29/2018 09:27:22 AM Central Daylight Time	08/03/2018 09:56:30 AM Central Daylight Time	07/31/2018 07:54:14 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE OF ILLINOIS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete (HMO)	01	01		1			H7445	004	0	2019	Carroll county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7464	001	0	1	01	01	H7464_001_0	3	1	2	1		05/31/2018	2019.01	05/31/2018 09:58:42 AM Central Daylight Time	08/03/2018 09:53:32 AM Central Daylight Time	07/31/2018 07:54:40 PM Central Daylight Time			08/06/2018 10:31:43 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H7464	001	0	2019	Select Counties in VA		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7501	001	0	1	20	08	H7501_001_0	3	1				05/24/2018	2019.01	05/24/2018 03:55:46 PM Pacific Daylight Time		06/04/2018 10:46:01 AM Pacific Daylight Time			06/04/2018 10:52:20 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	https://www.caloptima.org/en/Members/PACE.aspx	CalOptima PACE (PACE)	08	20		1			H7501	001	0	2019	Orange County, California		2		2			2						www.caloptima.org/home/providers/pharmacy.aspx	www.caloptima.org										(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(714)468-1063		(800)735-2929		(714)468-1063																
H7501	002	0	1	20	08	H7501_002_0	3	1				05/24/2018	2019.01	05/24/2018 03:56:17 PM Pacific Daylight Time		06/04/2018 10:46:11 AM Pacific Daylight Time			06/04/2018 10:52:20 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org	CalOptima PACE (PACE)	08	20		1			H7501	002	0	2019	Orange County		2		2			2						www.caloptima.org/home/providers/pharmacy.aspx	www.caloptima.org										(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(714)468-1063		(800)735-2929		(714)468-1063																
H7511	001	0	1	01	01	H7511_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:06:43 AM Eastern Daylight Time	08/07/2018 02:52:12 PM Eastern Daylight Time	08/07/2018 02:52:13 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Great Plains Medicare Advantage (HMO SNP)	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO SNP)	01	01		1			H7511	001	0	2019	Nebraska (partial)		2	6249	2			1	1	1				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7511	002	0	1	01	01	H7511_002_0	4	1		1		06/03/2018	2019.01	06/03/2018 03:12:35 PM Eastern Daylight Time	08/07/2018 02:52:13 PM Eastern Daylight Time	08/07/2018 02:52:13 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Great Plains Medicare Advantage (HMO SNP)	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage Gold (HMO SNP)	01	01		1			H7511	002	0	2019	Nebraska (partial)		2	1304	2			1	1	1				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7522	001	0	1	04	01	H7522_001_0	8	1				07/18/2018	2019.01	07/18/2018 10:11:24 PM SA Western Standard Time	08/06/2018 04:56:32 PM SA Western Standard Time	08/08/2018 02:09:12 PM SA Western Standard Time			08/09/2018 09:51:33 AM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.firstpluspr.com	MMM Advantage (PPO)	01	04		1			H7522	001	0	2019	Puerto Rico		2	12204	2			2						www.mmm-pr.com	www.mmm-pr.com	www.firstpluspr.com	(888)767-7717		(787)522-7800		(877)662-4242		(787)620-1282		(888)767-7717		(787)522-7800		(877)662-4242		(787)620-1282		(877)672-4242		(877)672-4242		(877)522-0655		(877)522-0655		(877)672-4242		(877)672-4242		(877)522-0655		(877)522-0655		2					2						1	01	7d;8a1;8b1;8b2;8b3;9a1;9a2;9b;12;	
H7522	801	0	1	04	01	H7522_801_0	4	1				06/02/2018	2019.01	06/02/2018 09:42:27 PM SA Western Standard Time					06/04/2018 04:52:43 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.firstpluspr.com	First+Plus Advantage Group Non Calendar (PPO)	01	04		1			H7522	801	0	2019	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmm-pr.com	www.firstpluspr.com	(888)767-7717		(787)522-7800		(877)662-4242		(787)620-1282		(888)767-7717		(787)522-7800		(877)662-4242		(787)620-1282		(877)672-4242		(877)672-4242		(877)522-0655		(877)522-0655		(877)672-4242		(877)672-4242		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	802	0	1	04	01	H7522_802_0	4	1				06/02/2018	2019.01	06/02/2018 09:44:32 PM SA Western Standard Time					06/04/2018 04:52:43 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.firstpluspr.com	First+Plus Advantage Group Calendar (PPO)	01	04		1			H7522	802	0	2019	Puerto Rico		1	11596	2			2						www.mmm-pr.com	www.mmm-pr.com	www.firstpluspr.com	(888)767-7717		(787)522-7800		(877)662-4242		(787)620-1282		(888)767-7717		(787)522-7800		(877)662-4242		(787)620-1282		(877)672-4242		(877)672-4242		(877)522-0655		(877)522-0655		(877)672-4242		(877)672-4242		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7619	001	0	1	20	08	H7619_001_0	1	1				05/22/2018	2019.01	05/22/2018 10:27:54 AM Eastern Daylight Time		05/22/2018 11:04:37 AM Eastern Daylight Time			05/22/2018 11:10:16 AM Eastern Daylight Time	ATLANTICARE HEALTH SERVICES, INC.	AtlantiCare LIFE Connection	www.atlanticare.org	AtlantiCare LIFE Connection (PACE)	08	20		1			H7619	001	0	2019	Atlantic and Cape May Counties		2		2			2						NA	NA										(888)569-1000		(609)407-2052		(888)569-1000		(609)407-2052												(800)852-7899				(800)852-7899																
H7619	002	0	1	20	08	H7619_002_0	1	1				05/22/2018	2019.01	05/22/2018 10:28:27 AM Eastern Daylight Time		05/22/2018 11:08:07 AM Eastern Daylight Time			05/22/2018 11:10:16 AM Eastern Daylight Time	ATLANTICARE HEALTH SERVICES, INC.	AtlantiCare LIFE Connection	www.atlanticare.org	AtlantiCare LIFE Connection (PACE)	08	20		1			H7619	002	0	2019	Counties: Atlantic, Cape May		2		2			2						NA	NA										(888)569-1000		(609)407-2052		(888)569-1000		(609)407-2052												(800)852-7899				(800)852-7899																
H7621	001	0	1	01	01	H7621_001_0	3	1				07/03/2018	2019.01	07/03/2018 03:49:56 PM Eastern Daylight Time	06/01/2018 02:47:24 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:21:17 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	001	0	2019	Select counties in Kansas City Metro area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7621	002	0	1	01	01	H7621_002_0	5	1				07/18/2018	2019.01	07/18/2018 05:23:57 PM Eastern Daylight Time	07/18/2018 02:06:00 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	002	0	2019	Riverside County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7621	003	0	1	01	01	H7621_003_0	4	1				07/02/2018	2019.01	07/02/2018 01:04:59 PM Eastern Daylight Time	08/03/2018 04:00:17 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 09:58:04 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	003	0	2019	San Joaquin County		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7660	001	0	1	20	08	H7660_001_0	1	1				05/23/2018	2019.01	05/23/2018 09:48:45 AM Eastern Daylight Time		05/23/2018 09:29:06 AM Eastern Daylight Time			05/23/2018 09:54:06 AM Eastern Daylight Time	VIECARE BEAVER, LLC	LIFE Beaver and Lawrence Counties	http://www.lutheranseniorlife.org	VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE)	08	20		1			H7660	001	0	2019	Beaver and Lawrence Counties		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)378-5400				(724)378-5400												(711)-				(711)-																
H7660	002	0	1	20	08	H7660_002_0	1	1				05/23/2018	2019.01	05/23/2018 09:48:57 AM Eastern Daylight Time		05/23/2018 09:28:28 AM Eastern Daylight Time			05/23/2018 09:54:06 AM Eastern Daylight Time	VIECARE BEAVER, LLC	LIFE Beaver and Lawrence Counties	www.LutheranSeniorLife.org	VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE)	08	20		1			H7660	002	0	2019	Beaver and Lawrence Counties		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)378-5400				(724)378-5400												(711)-				(711)-																
H7678	001	0	1	01	01	H7678_001_0	3	1	2	1		06/01/2018	2019.01	06/01/2018 04:24:47 PM Pacific Daylight Time	08/04/2018 10:28:46 AM Pacific Daylight Time	08/04/2018 11:21:18 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H7678	001	0	2019	Texas		2		2			1	3		1		1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)440-0012		(866)440-0012		(866)403-8293		(866)403-8293		(866)440-0012		(866)440-0012		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	001	0	1	01	01	H7680_001_0	8	1				08/06/2018	2019.01	08/06/2018 04:31:36 PM Pacific Daylight Time	08/06/2018 04:25:44 PM Pacific Daylight Time	08/06/2018 04:25:44 PM Pacific Daylight Time			08/06/2018 04:32:11 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H7680	001	0	2019	North Texas		2	16800	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	002	0	1	01	01	H7680_002_0	8	1				08/03/2018	2019.01	08/03/2018 01:24:09 PM Pacific Daylight Time	08/06/2018 04:25:45 PM Pacific Daylight Time	08/06/2018 04:25:45 PM Pacific Daylight Time			08/06/2018 04:33:43 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H7680	002	0	2019	South Texas		2	13188	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	801	0	1	01	01	H7680_801_0	2	1				05/09/2018	2019.01	05/09/2018 01:20:33 PM Pacific Daylight Time					06/04/2018 11:04:12 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	801	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7680	802	0	1	01	01	H7680_802_0	2	1				05/22/2018	2019.01	05/22/2018 01:49:29 PM Pacific Daylight Time					06/04/2018 11:05:31 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	802	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	803	0	1	01	01	H7680_803_0	2	1				05/09/2018	2019.01	05/09/2018 01:53:28 PM Pacific Daylight Time					06/04/2018 11:06:50 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	803	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	804	0	1	01	01	H7680_804_0	2	1				05/22/2018	2019.01	05/22/2018 10:25:44 AM Pacific Daylight Time					06/04/2018 11:08:11 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	804	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7680	805	0	1	01	01	H7680_805_0	2	1				05/22/2018	2019.01	05/22/2018 10:37:23 AM Pacific Daylight Time					06/04/2018 11:09:39 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	805	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	806	0	1	01	01	H7680_806_0	2	1				05/22/2018	2019.01	05/22/2018 11:31:42 AM Pacific Daylight Time					06/04/2018 11:11:38 AM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	806	0	2019	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7728	002	0	1	04	01	H7728_002_0	5	1				08/03/2018	2019.01	08/03/2018 10:05:52 PM Eastern Daylight Time	08/06/2018 01:36:03 AM Eastern Daylight Time	08/01/2018 08:26:54 PM Eastern Daylight Time			08/06/2018 06:18:09 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Access (PPO)	01	04		1			H7728	002	0	2019	Select Counties in New Hampshire		2	15412	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1787		(855)304-1787		(844)368-4245		(844)368-4245		(855)304-1787		(855)304-1787		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	004	1	1	04	01	H7728_004_1	7	1				08/03/2018	2019.01	08/03/2018 12:27:18 PM Eastern Daylight Time	08/06/2018 01:37:03 AM Eastern Daylight Time	08/01/2018 08:27:49 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Access (PPO)	01	04		1			H7728	004	1	2019	Select Counties in Kentucky	Lexington and Cincinnati	2	98520	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)690-7795		(855)690-7795		(844)368-4245		(844)368-4245		(855)690-7795		(855)690-7795		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	004	2	1	04	01	H7728_004_2	7	1				08/03/2018	2019.01	08/03/2018 12:29:41 PM Eastern Daylight Time	08/06/2018 01:38:04 AM Eastern Daylight Time	08/01/2018 08:28:40 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Access (PPO)	01	04		1			H7728	004	2	2019	Select Counties in Kentucky	Louisville	2	68688	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)690-7795		(855)690-7795		(844)368-4245		(844)368-4245		(855)690-7795		(855)690-7795		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	005	0	1	04	01	H7728_005_0	7	1				08/03/2018	2019.01	08/03/2018 10:58:38 AM Eastern Daylight Time	08/06/2018 01:39:05 AM Eastern Daylight Time	08/01/2018 08:29:32 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H7728	005	0	2019	Select Counties in Georgia		2	30480	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(844)368-4245		(844)368-4245		(866)438-9968		(866)438-9968		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	006	0	1	04	01	H7728_006_0	6	1				08/03/2018	2019.01	08/03/2018 09:33:12 PM Eastern Daylight Time	08/06/2018 01:40:05 AM Eastern Daylight Time	08/01/2018 08:30:23 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Basic (PPO)	01	04		1			H7728	006	0	2019	Select Counties in Georgia		2	20232	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(844)368-4245		(844)368-4245		(866)438-9968		(866)438-9968		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	801	0	1	04	01	H7728_801_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:23 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	801	0	2019	New Hampshire		1	79314	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	802	0	1	04	01	H7728_802_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:50 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	802	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	803	0	1	04	01	H7728_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:15:59 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	803	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	804	0	2	04	01	H7728_804_0	2	1				06/19/2018	2019.01	06/19/2018 01:16:33 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	804	0	2019	National		1	432	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	805	0	1	04	01	H7728_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:00 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	805	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	806	0	1	04	01	H7728_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:11 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	806	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	807	0	2	04	01	H7728_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:24 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	807	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	808	0	2	04	01	H7728_808_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:37 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	808	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	809	0	2	04	01	H7728_809_0	2	1				06/19/2018	2019.01	06/19/2018 01:17:49 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	809	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	810	0	1	04	01	H7728_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:00 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	810	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	811	0	1	04	01	H7728_811_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:11 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	811	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	812	0	1	04	01	H7728_812_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:25 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	812	0	2019	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7779	001	0	1	01	01	H7779_001_0	4	1		1		08/01/2018	2019.01	08/01/2018 03:20:18 PM Central Daylight Time	08/03/2018 04:07:51 PM Central Daylight Time	08/03/2018 04:08:20 PM Central Daylight Time			08/03/2018 04:13:17 PM Central Daylight Time	AMERICAN HEALTH PLAN, INC.	American Health Advantage of Tennessee	www.amhealthplans.com	American Health Advantage of Tennessee (HMO SNP)	01	01		1			H7779	001	0	2019	Tennessee		2	10621	2			1	1	3				www.amhealthplans.com	www.amhealthplans.com	www.amhealthplans.com	(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H7787	001	0	1	04	01	H7787_001_0	4	1				08/02/2018	2019.01	08/02/2018 01:33:31 PM Central Daylight Time	08/03/2018 11:11:29 AM Central Daylight Time	07/31/2018 08:54:11 PM Central Daylight Time			08/06/2018 12:00:22 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (PPO)	01	04		1			H7787	001	0	2019	North Texas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7787	002	0	1	04	01	H7787_002_0	3	1				05/27/2018	2019.01	05/27/2018 09:44:05 AM Central Daylight Time	07/16/2018 02:34:13 PM Central Daylight Time				07/19/2018 11:59:15 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (PPO)	01	04		1			H7787	002	0	2019	North Texas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7802	001	0	1	01	01	H7802_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:56:00 AM Eastern Daylight Time	08/07/2018 02:52:14 PM Eastern Daylight Time	08/07/2018 02:52:14 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN VA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan I-SNP (HMO SNP)	01	01		1			H7802	001	0	2019	Virginia (partial)		2	1113	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7802	002	0	1	01	01	H7802_002_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:56:24 AM Eastern Daylight Time	08/07/2018 02:52:14 PM Eastern Daylight Time	08/07/2018 02:52:14 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN VA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan C-SNP (HMO SNP)	01	01		1			H7802	002	0	2019	Virginia (partial)		2	770	2			1	4			00000100000000000000		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7802	003	0	1	01	01	H7802_003_0	4	1				08/03/2018	2019.01	08/03/2018 09:57:20 AM Eastern Daylight Time	08/07/2018 02:52:15 PM Eastern Daylight Time	08/07/2018 02:52:15 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN VA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO)	01	01		1			H7802	003	0	2019	Virginia (partial)		2	400	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7802	004	0	1	01	01	H7802_004_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:58:05 AM Eastern Daylight Time	08/07/2018 02:52:15 PM Eastern Daylight Time	08/07/2018 02:52:15 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	SPARTAN PLAN VA, INC.	Sunrise Advantage Plan (HMO SNP)	www.sunriseadvantageplan.com	Sunrise Advantage Plan Gold (HMO SNP)	01	01		1			H7802	004	0	2019	Virginia (partial)		2	571	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7833	001	0	1	48	05	H7833_001_0	3	1				08/09/2018	2019.01	08/09/2018 03:51:44 PM Eastern Daylight Time					08/09/2018 03:56:11 PM Eastern Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityplan.com	UnitedHealthcare Connected (Medicare-Medicaid Plan)	05	48		1			H7833	001	0	2019	Harris County		2	12	2			2						www.optumrx.com	www.UHCCommunityplan.com	www.UHCCommunityplan.com	(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7844	001	0	1	48	05	H7844_001_0	6	1				08/29/2018	2019.01	08/29/2018 11:31:58 AM Pacific Daylight Time					08/29/2018 02:20:03 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H7844	001	0	2019	Wayne and Macomb County		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5604		(855)735-5604		(855)701-4885		(855)701-4885		(855)735-5604		(855)735-5604		(855)701-4885		(855)701-4885		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7853	001	0	1	01	01	H7853_001_0	9	1				06/04/2018	2019.01	06/04/2018 05:06:32 PM Central Daylight Time	08/02/2018 01:32:34 PM Central Daylight Time	08/02/2018 11:12:16 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage (HMO)	01	01		1			H7853	001	0	2019	Greater Denver Area		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	002	0	1	01	01	H7853_002_0	9	1				06/04/2018	2019.01	06/04/2018 05:06:52 PM Central Daylight Time	08/02/2018 01:33:28 PM Central Daylight Time	08/02/2018 11:12:56 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Plus (HMO)	01	01		1			H7853	002	0	2019	Greater Denver Area		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	003	0	1	02	01	H7853_003_0	9	1				06/04/2018	2019.01	06/04/2018 05:07:34 PM Central Daylight Time	08/02/2018 01:35:18 PM Central Daylight Time	08/02/2018 11:13:38 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Choice (HMO-POS)	01	02		1			H7853	003	0	2019	Greater Denver Area		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	004	0	1	02	01	H7853_004_0	9	1				06/04/2018	2019.01	06/04/2018 05:07:52 PM Central Daylight Time	08/02/2018 01:36:30 PM Central Daylight Time	08/02/2018 11:14:18 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Choice Plus (HMO-POS)	01	02		1			H7853	004	0	2019	Greater Denver Area		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7855	001	0	1	20	08	H7855_001_0	1	1				05/23/2018	2019.01	05/23/2018 10:12:20 AM Pacific Daylight Time		05/23/2018 07:21:56 AM Pacific Daylight Time			05/23/2018 10:19:05 AM Pacific Daylight Time	BRANDMAN CENTERS FOR SENIOR CARE, INC.	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Dual (PACE)	08	20		1			H7855	001	0	2019	Brandman Centers for Senior Care-Dual		2		2			2						www.carekinesis.com	Not applicable										(855)744-8444	3033	(818)774-8444	3033	(855)774-8444		(818)774-8444										(818)774-3194		(818)774-3194		(818)774-3194		(818)774-3194																
H7855	002	0	1	20	08	H7855_002_0	1	1				05/23/2018	2019.01	05/23/2018 10:17:35 AM Pacific Daylight Time		05/23/2018 07:21:28 AM Pacific Daylight Time			05/23/2018 10:19:05 AM Pacific Daylight Time	BRANDMAN CENTERS FOR SENIOR CARE, INC.	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Medicare Only (PACE)	08	20		1			H7855	002	0	2019	Brandman Centers for Senior Care-Medicare Only		2		2			2						www.carekinesis.com	Not applicable										(855)774-8444		(818)774-8444		(855)774-8444		(818)774-8444										(818)774-3194		(818)774-3194		(818)774-3194		(818)774-3194																
H7885	001	0	1	48	05	H7885_001_0	4	1				07/05/2018	2019.01	07/05/2018 07:58:51 AM Pacific Daylight Time					07/05/2018 08:00:11 AM Pacific Daylight Time	SAN MATEO HEALTH COMMISSION	Health Plan of San Mateo	www.hpsm.org	CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H7885	001	0	2019	San Mateo County		2	108000	2			2						https://www.hpsm.org/providers/pharmacy.aspx	https://www.hpsm.org/search/formularies.aspx	https://www.hpsm.org/providers/provider-resources.aspx	(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929																
H7890	001	0	1	48	05	H7890_001_0	3	1				08/14/2018	2019.01	08/14/2018 03:09:53 PM Pacific Daylight Time					08/14/2018 03:39:34 PM Pacific Daylight Time	SANTA CLARA COUNTY HEALTH AUTHORITY	Santa Clara Family Health Plan Cal MediConnect	www.scfhp.com	Santa Clara Family Health Plan (Medicare-Medicaid Plan)	05	48		1			H7890	001	0	2019	Santa Clara County		2	90000	2			2						www.scfhp.com/healthcareplans/calmediconnect	www.scfhp.com	www.scfhp.com/healthcareplans/calmediconnect	(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929																
H7917	008	0	1	04	01	H7917_008_0	7	1				08/08/2018	2019.01	08/08/2018 11:58:26 AM Eastern Daylight Time	08/08/2018 09:59:48 AM Eastern Daylight Time	08/08/2018 10:00:30 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	008	0	2019	West Tennessee		2	4284	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	009	0	1	04	01	H7917_009_0	7	1				08/08/2018	2019.01	08/08/2018 11:58:33 AM Eastern Daylight Time	08/08/2018 10:01:40 AM Eastern Daylight Time	08/08/2018 10:02:20 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	009	0	2019	Middle Tennessee		2	12348	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	010	0	1	04	01	H7917_010_0	6	1				08/08/2018	2019.01	08/08/2018 11:58:38 AM Eastern Daylight Time	08/08/2018 10:03:26 AM Eastern Daylight Time	08/08/2018 10:04:04 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	010	0	2019	Southeast Tennessee		2	15600	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	011	0	1	04	01	H7917_011_0	8	1				08/08/2018	2019.01	08/08/2018 11:58:43 AM Eastern Daylight Time	08/08/2018 10:05:04 AM Eastern Daylight Time	08/08/2018 10:05:46 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	011	0	2019	Northeast Tennessee		2	43680	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	012	0	1	04	01	H7917_012_0	7	1				08/08/2018	2019.01	08/08/2018 11:59:22 AM Eastern Daylight Time	08/08/2018 10:06:52 AM Eastern Daylight Time	08/08/2018 10:07:30 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	012	0	2019	West Tennessee		2	14364	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	013	0	1	04	01	H7917_013_0	7	1				08/08/2018	2019.01	08/08/2018 11:59:18 AM Eastern Daylight Time	08/08/2018 10:08:36 AM Eastern Daylight Time	08/08/2018 10:09:18 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	013	0	2019	Middle Tennessee		2	27336	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	014	0	1	04	01	H7917_014_0	6	1				08/08/2018	2019.01	08/08/2018 11:59:13 AM Eastern Daylight Time	08/08/2018 10:10:18 AM Eastern Daylight Time	08/08/2018 10:10:56 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	014	0	2019	Southeast Tennessee		2	74880	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	015	0	1	04	01	H7917_015_0	6	1				08/08/2018	2019.01	08/08/2018 11:59:09 AM Eastern Daylight Time	08/08/2018 10:11:56 AM Eastern Daylight Time	08/08/2018 10:12:34 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	015	0	2019	Northeast Tennessee		2	29028	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	030	0	1	04	01	H7917_030_0	7	1				08/08/2018	2019.01	08/08/2018 11:59:04 AM Eastern Daylight Time	08/08/2018 10:13:34 AM Eastern Daylight Time	08/08/2018 10:14:22 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	030	0	2019	Southeast Tennessee		2	461244	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	031	0	1	04	01	H7917_031_0	7	1				08/08/2018	2019.01	08/08/2018 11:58:59 AM Eastern Daylight Time	08/08/2018 10:15:26 AM Eastern Daylight Time	08/08/2018 10:16:08 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	031	0	2019	Northeast Tennessee		2	138300	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	032	0	1	04	01	H7917_032_0	7	1				08/08/2018	2019.01	08/08/2018 11:58:55 AM Eastern Daylight Time	08/08/2018 10:17:22 AM Eastern Daylight Time	08/08/2018 10:18:06 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	032	0	2019	Middle Tennessee		2	460716	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	033	0	1	04	01	H7917_033_0	7	1				08/08/2018	2019.01	08/08/2018 11:58:51 AM Eastern Daylight Time	08/08/2018 10:19:12 AM Eastern Daylight Time	08/08/2018 10:19:54 AM Eastern Daylight Time			08/09/2018 08:58:02 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	033	0	2019	West Tennessee		2	220896	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	801	0	1	04	01	H7917_801_0	1	1				05/31/2018	2019.01	05/31/2018 01:41:43 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	801	0	2019	22 County Region		1	38340	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	802	0	1	04	01	H7917_802_0	1	1				05/31/2018	2019.01	05/31/2018 01:44:08 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	802	0	2019	22 County Region		1	100	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	803	0	1	04	01	H7917_803_0	1	1				06/01/2018	2019.01	06/01/2018 02:33:41 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	803	0	2019	22 County Region		1	100	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7971	001	0	1	04	01	H7971_001_0	6	1				05/31/2018	2019.01	05/31/2018 08:17:31 AM Eastern Daylight Time	08/06/2018 08:54:14 AM Eastern Daylight Time	08/06/2018 08:53:34 AM Eastern Daylight Time			08/07/2018 01:10:45 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue (PPO)	01	04		1			H7971	001	0	2019	Sussex County		2	324	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7971	801	0	1	04	01	H7971_801_0	1	1				05/09/2018	2019.01	05/09/2018 08:50:58 AM Eastern Daylight Time					05/16/2018 05:34:25 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group (PPO)	01	04		1			H7971	801	0	2019	National		1	28332	2			2						medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	802	0	1	04	01	H7971_802_0	3	1				05/09/2018	2019.01	05/09/2018 08:51:20 AM Eastern Daylight Time					05/16/2018 05:34:25 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/rx (PPO)	01	04		1			H7971	802	0	2019	National		1	84	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	805	0	1	04	01	H7971_805_0	3	1				05/09/2018	2019.01	05/09/2018 08:52:00 AM Eastern Daylight Time					05/16/2018 05:34:25 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Advantage NJ DIRECT10 (PPO)	01	04		1			H7971	805	0	2019	National		1	337620	2			2						medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	806	0	1	04	01	H7971_806_0	1	1				05/09/2018	2019.01	05/09/2018 08:55:39 AM Eastern Daylight Time					05/16/2018 05:34:25 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Advantage NJ DIRECT15 (PPO)	01	04		1			H7971	806	0	2019	National		1	322866	2			2						medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	807	0	1	04	01	H7971_807_0	1	1				05/09/2018	2019.01	05/09/2018 08:58:32 AM Eastern Daylight Time					05/16/2018 05:34:25 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/Rx Ideal (PPO)	01	04		1			H7971	807	0	2019	National		1	1500	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	808	0	1	04	01	H7971_808_0	1	1				05/09/2018	2019.01	05/09/2018 09:00:39 AM Eastern Daylight Time					05/16/2018 05:34:25 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/Rx Complete (PPO)	01	04		1			H7971	808	0	2019	National		1	1200	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H8003	001	0	1	04	01	H8003_001_0	8	1				07/02/2018	2019.01	07/02/2018 12:21:59 PM Eastern Daylight Time	08/02/2018 02:11:34 PM Eastern Daylight Time	08/01/2018 02:08:16 PM Eastern Daylight Time			08/02/2018 06:40:59 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	BlueCross Total (PPO)	01	04		1			H8003	001	0	2019	Upstate		2	50000	2			2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8003	002	0	1	04	01	H8003_002_0	8	1				07/02/2018	2019.01	07/02/2018 12:24:49 PM Eastern Daylight Time	08/02/2018 02:04:58 PM Eastern Daylight Time	08/01/2018 02:09:07 PM Eastern Daylight Time			08/02/2018 06:40:59 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	BlueCross Total (PPO)	01	04		1			H8003	002	0	2019	Midlands/Coastal		2	50000	2			2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8003	003	0	1	04	01	H8003_003_0	8	1				07/02/2018	2019.01	07/02/2018 12:27:03 PM Eastern Daylight Time	08/02/2018 02:05:46 PM Eastern Daylight Time	08/01/2018 02:10:00 PM Eastern Daylight Time			08/02/2018 06:40:59 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	BlueCross Total (PPO)	01	04		1			H8003	003	0	2019	Lowcountry		2	50000	2			2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8003	801	0	1	04	01	H8003_801_0	1	1				05/04/2018	2019.01	05/04/2018 11:57:25 AM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MAPD Calendar Year Group (PPO)	01	04		1			H8003	801	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8003	802	0	1	04	01	H8003_802_0	1	1				05/04/2018	2019.01	05/04/2018 12:05:11 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MAPD Non-calendar Year Group (PPO)	01	04		1			H8003	802	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8003	803	0	1	04	01	H8003_803_0	1	1				05/04/2018	2019.01	05/04/2018 03:46:32 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MA Only Calendar Year Group (PPO)	01	04		1			H8003	803	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H8003	804	0	1	04	01	H8003_804_0	1	1				05/04/2018	2019.01	05/04/2018 03:53:13 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan19	BlueCross MA Only Non-calendar Year Group (PPO)	01	04		1			H8003	804	0	2019	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	www.SCBluesMedAdvantage.com/retplan19	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H8010	002	0	1	01	01	H8010_002_0	13	1				08/06/2018	2019.01	08/06/2018 11:30:52 PM Pacific Daylight Time	08/07/2018 09:48:12 PM Pacific Daylight Time	08/01/2018 07:26:06 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	01	01		1			H8010	002	0	2019	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8010	003	0	1	01	01	H8010_003_0	13	1				08/07/2018	2019.01	08/07/2018 10:11:20 PM Pacific Daylight Time	08/07/2018 10:01:28 PM Pacific Daylight Time	08/01/2018 07:26:06 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Value (HMO)	01	01		1			H8010	003	0	2019	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8010	005	0	1	01	01	H8010_005_0	13	1				08/07/2018	2019.01	08/07/2018 03:37:53 PM Pacific Daylight Time	08/07/2018 09:48:10 PM Pacific Daylight Time	08/01/2018 07:26:10 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	01	01		1			H8010	005	0	2019	Bexar County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8010	008	0	1	01	01	H8010_008_0	13	1				08/07/2018	2019.01	08/07/2018 03:38:45 PM Pacific Daylight Time	08/07/2018 09:48:08 PM Pacific Daylight Time	08/01/2018 07:26:10 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	01	01		1			H8010	008	0	2019	El Paso County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8010	009	0	1	01	01	H8010_009_0	12	1				08/07/2018	2019.01	08/07/2018 03:39:21 PM Pacific Daylight Time	08/07/2018 09:48:06 PM Pacific Daylight Time	08/01/2018 07:25:50 PM Pacific Daylight Time			08/07/2018 11:08:41 PM Pacific Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Classic Plus (HMO)	01	01		1			H8010	009	0	2019	Bexar County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8016	001	0	1	48	05	H8016_001_0	3	1				07/19/2018	2019.01	07/19/2018 01:21:03 PM Pacific Daylight Time					07/19/2018 05:48:25 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	OneCare Connect	www.caloptima.org/onecareconnect	OneCare Connect (Medicare-Medicaid Plan)	05	48		1			H8016	001	0	2019	Orange County, California		2		2			2						http://www.caloptima.org/Home/Providers/Pharmacy.aspx	www.caloptima.org	www.caloptima.org/OneCareConnect	(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929																
H8026	001	0	1	48	05	H8026_001_0	6	1				09/04/2018	2019.01	09/04/2018 09:34:10 AM Central Daylight Time					09/04/2018 09:34:31 AM Central Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Better Health Premier Plan	www.aetnabetterhealth.com/michigan	Aetna Better Health Premier Plan (Medicare-Medicaid Plan)	05	48		1			H8026	001	0	2019	Wayne, Macomb and Southwest Michigan Regions		2	90000	2			2						www.aetnabetterhealth.com/michigan	www.aetnabetterhealth.com/michigan	www.aetnabetterhealth.com/michigan	(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8029	001	0	1	48	05	H8029_001_0	5	1				08/22/2018	2019.01	08/22/2018 07:58:14 PM Eastern Daylight Time					08/22/2018 07:59:04 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan FIDA Total Care	www.elderplanfida.org	Elderplan FIDA Total Care (Medicare-Medicaid Plan)	05	48		1			H8029	001	0	2019	Ki, Qu, Brx, NY, Ri, and Na		2	7530	2			2						www.caremark.com	www.elderplanfida.org	www.elderplanfida.org	(855)462-3167		(718)921-7979		(866)695-8101		(866)695-8101		(855)462-3167		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8046	001	0	1	48	05	H8046_001_0	3	1				08/22/2018	2019.01	08/22/2018 10:02:10 AM Pacific Daylight Time					08/22/2018 02:55:09 PM Pacific Daylight Time	MOLINA HEALTHCARE OF ILLINOIS, INC.	Molina Healthcare of Illinois	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8046	001	0	2019	Davenport, Peoria, Champaign, Chicago		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(877)901-8181		(877)901-8181		(855)895-9987		(855)895-9987		(877)901-8181		(877)901-8181		(855)895-9987		(855)895-9987		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8064	002	0	1	04	01	H8064_002_0	4	1				08/03/2018	2019.01	08/03/2018 03:15:15 PM Pacific Daylight Time	08/01/2018 04:46:18 PM Pacific Daylight Time	07/31/2018 03:48:37 PM Pacific Daylight Time			08/03/2018 06:15:37 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct PPO Plus (PPO)	01	04		1			H8064	002	0	2019	South Central North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8067	001	0	1	01	01	H8067_001_0	5	1		1		08/03/2018	2019.01	08/03/2018 11:09:41 AM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time			08/07/2018 03:07:55 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN, INC.	Provider Partners Maryland Advantage Plan	pphealthplan.com	Provider Partners Maryland Advantage Plan (HMO SNP)	01	01		1			H8067	001	0	2019	Western & Central Maryland		2	18906	2			1	1	1				pphealthplan.com	pphealthplan.com	pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H8067	002	0	1	01	01	H8067_002_0	5	1		1		08/03/2018	2019.01	08/03/2018 11:10:23 AM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time	08/07/2018 03:03:04 PM Eastern Daylight Time			08/07/2018 03:07:55 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN, INC.	Provider Partners Maryland Advantage Plan	pphealthplan.com	Provider Partners Illinois Advantage Plan (HMO SNP)	01	01		1			H8067	002	0	2019	Cook County		2	4680	2			1	1	1				pphealthplan.com	pphealthplan.com	pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H8087	001	0	1	04	01	H8087_001_0	4	1				07/11/2018	2019.01	07/11/2018 03:45:41 PM Eastern Daylight Time	06/01/2018 01:30:08 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H8087-001 (PPO)	01	04		1			H8087	001	0	2019	Select counties in Michigan		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8087	002	0	1	04	01	H8087_002_0	3	1				07/05/2018	2019.01	07/05/2018 02:05:45 PM Eastern Daylight Time	08/03/2018 01:41:26 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H8087-002 (PPO)	01	04		1			H8087	002	0	2019	Select counties in Michigan		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8096	001	0	1	20	08	H8096_001_0	1	1				05/29/2018	2019.01	05/29/2018 02:27:03 PM Eastern Daylight Time		05/29/2018 02:21:48 PM Eastern Daylight Time			05/29/2018 02:30:38 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrapace.com	Centra PACE - Dual (PACE)	08	20		1			H8096	001	0	2019	Centra PACE - Lynchburg, Farmville, & Gretna VA		2		2			2						www.centrahealth.com	http:\\www.centrahealth.com										(888)316-9540		(434)200-6516		(888)316-9540		(434)200-6516										(800)828-1140		(800)828-1140		(800)828-1140		(800)828-1140																
H8096	002	0	1	20	08	H8096_002_0	1	1				05/29/2018	2019.01	05/29/2018 02:27:50 PM Eastern Daylight Time		05/29/2018 02:21:33 PM Eastern Daylight Time			05/29/2018 02:30:38 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrapace.com	Centra PACE - Medicare only (PACE)	08	20		1			H8096	002	0	2019	Centra PACE - Lynchburg, Farmville, & Gretna VA		2		2			2						www.centrahealth.com	http:\\www.centrahealth.com										(888)316-9540		(434)200-6516		(888)316-9540		(434)200-6516										(800)828-1140		(800)828-1140		(800)828-1140		(800)828-1140																
H8130	001	0	1	01	01	H8130_001_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 11:03:27 AM Pacific Daylight Time	08/04/2018 10:30:06 AM Pacific Daylight Time	08/04/2018 11:22:34 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H8130	001	0	2019	Tampa, West Palm Beach, Miami		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)553-9494		(866)553-9494		(866)403-8293		(866)403-8293		(866)553-9494		(866)553-9494		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	001	0	1	01	01	H8133_001_0	7	1				07/09/2018	2019.01	07/09/2018 12:22:21 PM Central Daylight Time	08/06/2018 12:54:46 PM Central Daylight Time	08/01/2018 11:58:05 AM Central Daylight Time			08/07/2018 01:30:54 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	001	0	2019	Houston Metro Area		2	31510	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	003	0	1	01	01	H8133_003_0	7	1				07/09/2018	2019.01	07/09/2018 12:22:12 PM Central Daylight Time	08/06/2018 12:55:31 PM Central Daylight Time	08/01/2018 11:58:50 AM Central Daylight Time			08/07/2018 01:30:54 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	003	0	2019	El Paso		2	3139	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	005	0	1	01	01	H8133_005_0	7	1				07/09/2018	2019.01	07/09/2018 12:22:03 PM Central Daylight Time	08/06/2018 12:56:18 PM Central Daylight Time	08/01/2018 11:59:35 AM Central Daylight Time			08/07/2018 01:30:54 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	005	0	2019	South Texas		2	20605	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	007	0	1	01	01	H8133_007_0	7	1				07/09/2018	2019.01	07/09/2018 12:17:18 PM Central Daylight Time	08/06/2018 12:57:03 PM Central Daylight Time	08/01/2018 12:00:20 PM Central Daylight Time			08/07/2018 01:30:54 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	007	0	2019	Austin		2	7835	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	009	0	1	01	01	H8133_009_0	5	1	2	1		05/30/2018	2019.01	05/30/2018 09:43:02 AM Central Daylight Time	08/06/2018 02:22:29 PM Central Daylight Time	08/01/2018 12:01:08 PM Central Daylight Time			08/07/2018 01:30:54 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/dsnp	Blue Cross Medicare Advantage Dual Care (HMO SNP)	01	01		1			H8133	009	0	2019	Bastrp,Burnet,Caldwl,Hays,Lee,&Wilmson ctys		2	103	2			1	3		2		2	www.getbluetx.com/dsnp/pharmacies	www.getbluetx.com/dsnp/druglist	www.getbluetx.com/dsnp/providers	(877)895-6437		(877)895-6437		(877)583-8129		(877)583-8129		(877)895-6437		(877)895-6437		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	801	0	1	01	01	H8133_801_0	2	1				06/18/2018	2019.01	06/18/2018 01:41:26 PM Central Daylight Time					06/18/2018 01:56:46 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	801	0	2019	Houston		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H8133	803	0	1	01	01	H8133_803_0	2	1				06/18/2018	2019.01	06/18/2018 01:41:35 PM Central Daylight Time					06/18/2018 01:56:46 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	803	0	2019	Houston		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H8133	805	0	1	01	01	H8133_805_0	2	1				06/18/2018	2019.01	06/18/2018 01:41:43 PM Central Daylight Time					06/18/2018 01:56:46 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	805	0	2019	Houston		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					1				
H8142	001	0	1	01	01	H8142_001_0	5	1				06/27/2018	2019.01	06/27/2018 11:35:09 AM Central Daylight Time	08/06/2018 03:19:38 PM Central Daylight Time	08/02/2018 09:59:04 AM Central Daylight Time			08/07/2018 08:25:30 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Select Rx (HMO)	01	01		1			H8142	001	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8142	002	0	1	01	01	H8142_002_0	4	1				06/27/2018	2019.01	06/27/2018 11:39:26 AM Central Daylight Time	08/06/2018 03:20:44 PM Central Daylight Time	08/02/2018 10:02:04 AM Central Daylight Time			08/07/2018 08:25:30 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Preferred Rx (HMO)	01	01		1			H8142	002	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8142	003	0	1	01	01	H8142_003_0	4	1				06/27/2018	2019.01	06/27/2018 11:43:04 AM Central Daylight Time	08/06/2018 03:21:38 PM Central Daylight Time	08/02/2018 10:02:40 AM Central Daylight Time			08/07/2018 08:25:30 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Premium Rx (HMO)	01	01		1			H8142	003	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8142	004	0	1	01	01	H8142_004_0	4	1				06/27/2018	2019.01	06/27/2018 11:45:30 AM Central Daylight Time	07/03/2018 10:15:58 AM Central Daylight Time				07/10/2018 11:43:42 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Select (HMO)	01	01		1			H8142	004	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8142	005	0	1	01	01	H8142_005_0	3	1				06/27/2018	2019.01	06/27/2018 11:47:58 AM Central Daylight Time	06/04/2018 07:52:34 PM Central Daylight Time				07/11/2018 10:03:52 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Preferred (HMO)	01	01		1			H8142	005	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8142	006	0	1	01	01	H8142_006_0	3	1				06/27/2018	2019.01	06/27/2018 11:54:27 AM Central Daylight Time	06/04/2018 07:51:32 PM Central Daylight Time				07/11/2018 10:03:52 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Baylor Scott & White Health Plan	advantage.swhp.org	SeniorCare Advantage Premium (HMO)	01	01		1			H8142	006	0	2019	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	003	0	1	09	04	H8145_003_0	4	1				07/03/2018	2019.01	07/03/2018 04:03:39 PM Eastern Daylight Time	07/17/2018 10:22:57 AM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:24:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-003 (PFFS)	04	09	1	1			H8145	003	0	2019	Select Counties in Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	004	0	1	09	04	H8145_004_0	5	1				07/11/2018	2019.01	07/11/2018 12:30:31 PM Eastern Daylight Time	07/17/2018 10:08:49 AM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:24:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-004 (PFFS)	04	09	1	1			H8145	004	0	2019	Select Counties in Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	006	0	1	09	04	H8145_006_0	5	1				07/03/2018	2019.01	07/03/2018 11:45:24 AM Eastern Daylight Time	07/18/2018 03:00:08 PM Eastern Daylight Time	08/03/2018 09:21:23 AM Eastern Daylight Time			08/06/2018 10:39:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-006 (PFFS)	04	09	1	1			H8145	006	0	2019	Select Counties in Michigan and Wisconsin		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	008	0	1	09	04	H8145_008_0	5	1				07/05/2018	2019.01	07/05/2018 06:03:54 PM Eastern Daylight Time	07/18/2018 02:56:21 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:39:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-008 (PFFS)	04	09	1	1			H8145	008	0	2019	Select Counties in Illinois		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	011	0	1	09	04	H8145_011_0	5	1				07/18/2018	2019.01	07/18/2018 05:42:35 PM Eastern Daylight Time	08/03/2018 01:35:45 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-011 (PFFS)	04	09	1	1			H8145	011	0	2019	Select Counties in Indiana		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	021	0	1	09	04	H8145_021_0	3	1				07/05/2018	2019.01	07/05/2018 01:49:09 PM Eastern Daylight Time	06/01/2018 01:34:29 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:32:54 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-021 (PFFS)	04	09	1	1			H8145	021	0	2019	Select Counties in Kentucky and West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	032	0	1	09	04	H8145_032_0	4	1				07/03/2018	2019.01	07/03/2018 04:22:33 PM Eastern Daylight Time	06/01/2018 01:12:11 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-032 (PFFS)	04	09	1	1			H8145	032	0	2019	Select Counties in Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	042	0	1	09	04	H8145_042_0	4	1				07/11/2018	2019.01	07/11/2018 12:38:20 PM Eastern Daylight Time	07/17/2018 10:23:27 AM Eastern Daylight Time				07/18/2018 04:36:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-042 (PFFS)	04	09	1	1			H8145	042	0	2019	Select Counties in Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	050	0	1	09	04	H8145_050_0	2	1				07/05/2018	2019.01	07/05/2018 01:49:25 PM Eastern Daylight Time	06/01/2018 01:33:05 PM Eastern Daylight Time				07/06/2018 04:36:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-050 (PFFS)	04	09	1	1			H8145	050	0	2019	Select Counties in West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	051	0	1	09	04	H8145_051_0	3	1				07/05/2018	2019.01	07/05/2018 01:49:42 PM Eastern Daylight Time	06/01/2018 01:33:33 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:32:54 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-051 (PFFS)	04	09	1	1			H8145	051	0	2019	Select Counties in West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	052	0	1	09	04	H8145_052_0	5	1				07/18/2018	2019.01	07/18/2018 05:11:29 PM Eastern Daylight Time	06/01/2018 01:34:57 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:32:54 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-052 (PFFS)	04	09	1	1			H8145	052	0	2019	Select Counties in Pennsylvania		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	055	0	1	09	04	H8145_055_0	3	1				07/11/2018	2019.01	07/11/2018 12:24:55 PM Eastern Daylight Time	06/01/2018 01:35:25 PM Eastern Daylight Time				07/12/2018 02:26:39 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-055 (PFFS)	04	09	1	1			H8145	055	0	2019	Select Counties in Pennsylvania		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	061	0	1	09	04	H8145_061_0	5	1				07/11/2018	2019.01	07/11/2018 03:40:43 PM Eastern Daylight Time	07/18/2018 02:04:59 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-061 (PFFS)	04	09	1	1			H8145	061	0	2019	Select Counties in Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	063	0	1	09	04	H8145_063_0	5	1				07/11/2018	2019.01	07/11/2018 01:10:33 PM Eastern Daylight Time	07/17/2018 10:08:20 AM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:54:54 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-063 (PFFS)	04	09	1	1			H8145	063	0	2019	North Carolina Select		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	069	0	1	09	04	H8145_069_0	4	1				07/11/2018	2019.01	07/11/2018 02:28:44 PM Eastern Daylight Time	08/03/2018 01:35:01 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:13:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-069 (PFFS)	04	09	1	1			H8145	069	0	2019	Select Counties in Georgia and South Carolina		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	075	0	1	09	04	H8145_075_0	4	1				07/02/2018	2019.01	07/02/2018 03:28:54 PM Eastern Daylight Time	06/01/2018 01:25:11 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-075 (PFFS)	04	09	1	1			H8145	075	0	2019	Select Counties in Alabama		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	084	0	1	09	04	H8145_084_0	5	1				07/11/2018	2019.01	07/11/2018 01:41:49 PM Eastern Daylight Time	06/01/2018 03:09:01 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 12:39:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-084 (PFFS)	04	09	1	1			H8145	084	0	2019	Select Counties in Texas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	087	0	1	09	04	H8145_087_0	3	1				07/02/2018	2019.01	07/02/2018 12:11:19 PM Eastern Daylight Time	06/01/2018 03:15:38 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-087 (PFFS)	04	09	1	1			H8145	087	0	2019	Select Counties in Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	089	0	1	09	04	H8145_089_0	5	1				07/05/2018	2019.01	07/05/2018 05:18:15 PM Eastern Daylight Time	07/18/2018 02:57:46 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:39:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-089 (PFFS)	04	09	1	1			H8145	089	0	2019	Select Counties in IA, MN, MT, ND, SD		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	091	0	1	09	04	H8145_091_0	4	1				07/02/2018	2019.01	07/02/2018 03:44:50 PM Eastern Daylight Time	06/02/2018 03:08:06 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:49:11 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-091 (PFFS)	04	09	1	1			H8145	091	0	2019	Select Counties in Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	103	0	1	09	04	H8145_103_0	6	1				07/11/2018	2019.01	07/11/2018 01:37:54 PM Eastern Daylight Time	07/17/2018 02:59:43 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 12:39:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-103 (PFFS)	04	09	1	1			H8145	103	0	2019	Select Counties in Arizona		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	108	0	1	09	04	H8145_108_0	2	1				07/02/2018	2019.01	07/02/2018 03:40:38 PM Eastern Daylight Time	06/01/2018 01:26:10 PM Eastern Daylight Time				07/06/2018 01:52:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-108 (PFFS)	04	09	1	1			H8145	108	0	2019	Select Counties in Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	120	0	1	09	04	H8145_120_0	2	1				07/02/2018	2019.01	07/02/2018 02:32:33 PM Eastern Daylight Time	06/01/2018 02:29:12 PM Eastern Daylight Time				07/06/2018 02:10:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-120 (PFFS)	04	09	1	1			H8145	120	0	2019	Select counties in AR, CO, KS, MO and OK		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	121	0	1	09	04	H8145_121_0	3	1				07/05/2018	2019.01	07/05/2018 05:24:46 PM Eastern Daylight Time	07/18/2018 02:58:15 PM Eastern Daylight Time				07/18/2018 04:51:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-121 (PFFS)	04	09	1	1			H8145	121	0	2019	Select Counties in Illinois and Michigan		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	122	0	1	09	04	H8145_122_0	3	1				07/02/2018	2019.01	07/02/2018 02:32:46 PM Eastern Daylight Time	08/03/2018 06:03:12 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:35:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-122 (PFFS)	04	09	1	1			H8145	122	0	2019	Select counties in Arkansas, Kansas and Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	123	0	1	09	04	H8145_123_0	4	1				07/02/2018	2019.01	07/02/2018 05:18:51 PM Eastern Daylight Time	06/01/2018 03:17:31 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 12:39:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-123 (PFFS)	04	09	1	1			H8145	123	0	2019	Select Counties in Colorado and New Mexico		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H8145	125	0	1	09	04	H8145_125_0	4	1				07/03/2018	2019.01	07/03/2018 03:06:25 PM Eastern Daylight Time	06/02/2018 03:08:12 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:35:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-125 (PFFS)	04	09	1	1			H8145	125	0	2019	Select counties in Missouri		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	126	0	1	09	04	H8145_126_0	4	1				07/11/2018	2019.01	07/11/2018 01:42:32 PM Eastern Daylight Time	06/01/2018 03:09:40 PM Eastern Daylight Time				07/12/2018 02:28:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-126 (PFFS)	04	09	1	1			H8145	126	0	2019	Select Counties in Texas		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	155	0	1	09	04	H8145_155_0	4	1				07/05/2018	2019.01	07/05/2018 05:08:40 PM Eastern Daylight Time	07/18/2018 03:01:14 PM Eastern Daylight Time				07/18/2018 06:14:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-155 (PFFS)	04	09	1	1			H8145	155	0	2019	Select Counties in Iowa		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8170	001	0	1	01	01	H8170_001_0	12	1				06/22/2018	2019.01	06/22/2018 10:56:37 AM Eastern Daylight Time	08/01/2018 03:54:16 PM Eastern Daylight Time	08/01/2018 03:58:34 PM Eastern Daylight Time			08/03/2018 04:55:41 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE OF SOUTH CAROLINA, INC.	America's 1st Choice of South Carolina	www.americas1stchoice.com	AFC Care Rx (HMO)	01	01		1			H8170	001	0	2019	Select Counties in SC		2	0	2			2						www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8170	002	0	1	01	01	H8170_002_0	12	1		1		06/22/2018	2019.01	06/22/2018 10:56:50 AM Eastern Daylight Time	08/01/2018 03:55:34 PM Eastern Daylight Time	08/01/2018 03:59:24 PM Eastern Daylight Time			08/03/2018 04:55:41 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE OF SOUTH CAROLINA, INC.	America's 1st Choice of South Carolina	www.americas1stchoice.com	AFC Special Care Rx (HMO SNP)	01	01		1			H8170	002	0	2019	Select Counties in SC		2	0	2			1	4			00000000000000000010		www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8189	001	0	1	01	01	H8189_001_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 11:16:49 AM Pacific Daylight Time	08/04/2018 10:44:51 AM Pacific Daylight Time	08/04/2018 10:45:47 AM Pacific Daylight Time			08/04/2018 11:25:58 AM Pacific Daylight Time	MANAGED HEALTH SERVICES, WISCONSIN	Allwell	allwell.mhswi.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H8189	001	0	2019	Southeastern, Northeastern, Central Counties		2		2			1	3		1		1	allwell.mhswi.com/findadoctor	allwell.mhswi.com/formulary	allwell.mhswi.com/findadoctor	(877)935-8024		(877)935-8024		(877)826-5521		(877)826-5521		(877)935-8024		(877)935-8024		(877)826-5521		(877)826-5521		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8197	001	0	1	48	05	H8197_001_0	4	1				08/23/2018	2019.01	08/23/2018 03:35:45 PM Pacific Daylight Time					08/23/2018 03:36:16 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8197	001	0	2019	Texas		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(866)856-8699		(866)856-8699		(855)895-9992		(855)895-9992		(866)856-8699		(866)856-8699		(855)895-9992		(855)895-9992		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8211	001	0	1	04	01	H8211_001_0	4	1				07/12/2018	2019.01	07/12/2018 12:46:45 PM Central Daylight Time	08/03/2018 09:54:57 AM Central Daylight Time	07/31/2018 07:55:28 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H8211	001	0	2019	Select Counties in West Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8211	002	0	1	04	01	H8211_002_0	4	1				07/12/2018	2019.01	07/12/2018 12:47:05 PM Central Daylight Time	08/03/2018 09:55:42 AM Central Daylight Time	07/31/2018 07:55:50 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H8211	002	0	2019	Select Counties in West Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8211	003	0	1	04	01	H8211_003_0	4	1				07/12/2018	2019.01	07/12/2018 12:47:32 PM Central Daylight Time	08/03/2018 09:56:23 AM Central Daylight Time	07/31/2018 07:56:14 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H8211	003	0	2019	Charleston and Huntington Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8211	004	0	1	04	01	H8211_004_0	4	1				07/12/2018	2019.01	07/12/2018 12:47:54 PM Central Daylight Time	08/03/2018 09:57:11 AM Central Daylight Time	07/31/2018 07:56:36 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H8211	004	0	2019	Charleston and Huntington Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8213	001	0	1	48	05	H8213_001_0	7	1				08/15/2018	2019.01	08/15/2018 11:42:08 AM Central Daylight Time					08/15/2018 11:50:56 AM Central Daylight Time	SELECT HEALTH OF SOUTH CAROLINA, INC.	FIRST CHOICE VIP CARE PLUS	http://www.firstchoicevipcareplus.com	First Choice VIP Care Plus (Medicare-Medicaid Plan)	05	48		1			H8213	001	0	2019	South Carolina - 39 counties		2		2			2						http://www.firstchoicevipcareplus.com	http://www.firstchoicevipcareplus.com	http://www.firstchoicevipcareplus.com	(888)978-0862		(888)978-0862		(877)694-2314		(877)694-2314		(888)978-0862		(888)978-0862		(877)694-2314		(877)694-2314		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8258	001	0	1	48	05	H8258_001_0	5	1				08/10/2018	2019.01	08/10/2018 10:44:46 AM Pacific Daylight Time					08/10/2018 11:39:34 AM Pacific Daylight Time	LOCAL INITIATIVE HEALTH AUTHORITY FOR L.A. COUNTY	L.A. Care Cal MediConnect Plan	www.calmediconnectla.org	L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H8258	001	0	2019	Los Angeles County		2	153180	2			2						www.calmediconnectla.org	www.calmediconnectla.org	www.calmediconnectla.org	(888)522-1298		(888)522-1298		(855)522-8243		(855)522-8243		(888)522-1298		(888)522-1298		(855)522-8243		(855)522-8243		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8266	001	0	1	01	01	H8266_001_0	4	1				07/23/2018	2019.01	07/23/2018 10:05:13 AM SA Western Standard Time	08/01/2018 10:36:32 AM SA Western Standard Time	08/01/2018 10:26:14 AM SA Western Standard Time			08/06/2018 02:56:33 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Apollo Constellation Health (HMO)	01	01		1			H8266	001	0	2019	Puerto Rico		2	91529	2			2						www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H8266	002	0	1	01	01	H8266_002_0	4	1				07/23/2018	2019.01	07/23/2018 10:06:04 AM SA Western Standard Time	08/01/2018 10:35:36 AM SA Western Standard Time	08/01/2018 10:26:54 AM SA Western Standard Time			08/06/2018 02:56:33 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Orion Constellation Health (HMO)	01	01		1			H8266	002	0	2019	Puerto Rico		2	1612	2			2						www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H8266	004	0	1	01	01	H8266_004_0	4	1				07/23/2018	2019.01	07/23/2018 10:08:43 AM SA Western Standard Time	08/01/2018 10:34:40 AM SA Western Standard Time	08/01/2018 10:27:36 AM SA Western Standard Time			08/06/2018 02:56:33 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Apollo @ Home Constellation Health (HMO)	01	01		1			H8266	004	0	2019	Puerto Rico		2	2687	2			2						www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)714-0724		(787)304-4040		(844)304-4040		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H8280	001	0	1	01	01	H8280_001_0	9	1				06/04/2018	2019.01	06/04/2018 05:08:17 PM Central Daylight Time	08/02/2018 01:37:24 PM Central Daylight Time	08/02/2018 11:14:56 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage (HMO)	01	01		1			H8280	001	0	2019	Jefferson and Shelby Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8280	002	0	1	01	01	H8280_002_0	11	1				07/06/2018	2019.01	07/06/2018 12:46:00 PM Central Daylight Time	08/02/2018 01:38:20 PM Central Daylight Time	08/02/2018 11:15:34 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Plus (HMO)	01	01		1			H8280	002	0	2019	Jefferson and Shelby Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8280	003	0	1	02	01	H8280_003_0	9	1				06/04/2018	2019.01	06/04/2018 05:08:59 PM Central Daylight Time	08/02/2018 01:39:16 PM Central Daylight Time	08/02/2018 11:16:12 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Choice (HMO-POS)	01	02		1			H8280	003	0	2019	Jefferson and Shelby Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8280	004	0	1	02	01	H8280_004_0	11	1				07/06/2018	2019.01	07/06/2018 12:46:14 PM Central Daylight Time	08/02/2018 01:40:12 PM Central Daylight Time	08/02/2018 11:16:50 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Choice Plus (HMO-POS)	01	02		1			H8280	004	0	2019	Jefferson and Shelby Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8298	001	0	1	01	01	H8298_001_0	8	1	2	1		08/06/2018	2019.01	08/06/2018 07:37:32 AM Eastern Daylight Time	08/06/2018 08:59:09 AM Eastern Daylight Time	08/06/2018 08:58:18 AM Eastern Daylight Time			08/07/2018 01:10:45 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.Horizonblue.com/Medicare	Horizon NJ TotalCare (HMO SNP)	01	01		1			H8298	001	0	2019	New Jersey		2	161325	2			1	3		1		1	www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://doctorfinder.horizonblue.com/	(800)543-5656		(800)543-5656		(888)765-7134		(888)765-7134		(855)457-1346		(855)457-1346		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8423	001	0	1	48	05	H8423_001_0	6	1				08/23/2018	2019.01	08/23/2018 03:07:45 PM Central Daylight Time					08/23/2018 08:47:42 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring CarePlan	www.CarePlanTX.com	Cigna-HealthSpring CarePlan (Medicare-Medicaid Plan)	05	48		1			H8423	001	0	2019	Select TX Counties		2		2			2						www.mycignahealthspring.com	www.CarePlanTX.com	www.CarePlanTX.com	(877)653-0327		(877)653-0327		(877)653-0327		(877)653-0327		(877)653-0327		(877)653-6725		(877)653-0327		(877)653-0327		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8424	001	0	1	20	08	H8424_001_0	1	1				06/01/2018	2019.01	06/01/2018 10:31:11 AM Central Daylight Time		06/01/2018 10:12:15 AM Central Daylight Time			06/01/2018 10:40:03 AM Central Daylight Time	SIOUXLAND PACE, INC.	SIOUXLAND PACE, INC.	https://www.unitypoint.org/siouxcity/services-pace	Siouxland PACE, INC (PACE)	08	20		1			H8424	001	0	2019	Siouxland PACE, INC		2		2			2						https://www.unitypoint.org/siouxcity/services-pace.aspx	https://www.unitypoint.org/siouxcity/services-pace.aspx										(888)722-3713		(712)224-7223	258	(888)722-3713		(712)224-7223	258									(800)383-4545		(712)224-7253		(800)383-4545		(712)224-7253																
H8424	002	0	1	20	08	H8424_002_0	1	1				06/01/2018	2019.01	06/01/2018 10:32:42 AM Central Daylight Time		06/01/2018 10:39:33 AM Central Daylight Time			06/01/2018 10:40:03 AM Central Daylight Time	SIOUXLAND PACE, INC.	SIOUXLAND PACE, INC.	www.siouxlandpace.org	Siouxland PACE, INC (PACE)	08	20		1			H8424	002	0	2019	Siouxland PACE, INC		2		2			2						https://www.unitypoint.org/siouxcity/services-pace.aspx	https://www.unitypoint.org/siouxcity/services-pace.aspx										(888)722-3713		(712)224-7223		(888)722-3713		(712)224-7223										(800)383-4545		(712)224-7253		(800)383-4545		(712)224-7253																
H8432	002	0	1	01	01	H8432_002_0	5	1	2	1		08/03/2018	2019.01	08/03/2018 09:02:00 PM Eastern Daylight Time	08/06/2018 01:41:05 AM Eastern Daylight Time	08/01/2018 08:24:04 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/shop	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H8432	002	0	2019	Select Counties in Maine		2	50012	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)887-6351		(844)887-6351		(844)296-3997		(844)296-3997		(844)887-6351		(844)887-6351		(844)296-7202		(844)296-7202		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	005	0	1	02	01	H8432_005_0	6	1				08/06/2018	2019.01	08/06/2018 01:43:45 PM Eastern Daylight Time	08/06/2018 01:42:05 AM Eastern Daylight Time	08/01/2018 08:31:08 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Anthem MediBlue Choice (HMO-POS)	01	02		1			H8432	005	0	2019	Androscoggin, Cumberland, Kennebec, Knox, York		2	807	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	006	0	1	02	01	H8432_006_0	6	1				08/06/2018	2019.01	08/06/2018 01:44:01 PM Eastern Daylight Time	08/06/2018 01:43:04 AM Eastern Daylight Time	08/01/2018 08:31:50 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Anthem MediBlue Choice (HMO-POS)	01	02		1			H8432	006	0	2019	Penobscot		2	153	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	007	0	1	01	01	H8432_007_0	4	1	2	1		08/04/2018	2019.01	08/04/2018 05:42:31 AM Eastern Daylight Time	08/06/2018 01:44:04 AM Eastern Daylight Time	08/01/2018 08:25:28 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage (HMO SNP)	01	01		1			H8432	007	0	2019	New York City Area		2	113388	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(844)630-1023		(844)630-1023		(877)269-5706		(877)269-5706		(844)630-1024		(844)630-1024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	008	5	1	01	01	H8432_008_5	5	1				08/04/2018	2019.01	08/04/2018 10:42:19 AM Eastern Daylight Time	08/06/2018 01:45:04 AM Eastern Daylight Time	08/01/2018 08:32:33 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	008	5	2019	New York City Area	Bronx	2	44528	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	008	6	1	01	01	H8432_008_6	5	1				08/03/2018	2019.01	08/03/2018 03:47:34 PM Eastern Daylight Time	08/06/2018 01:46:03 AM Eastern Daylight Time	08/01/2018 08:33:15 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	008	6	2019	New York City Area	Queens	2	105119	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	008	7	1	01	01	H8432_008_7	5	1				08/03/2018	2019.01	08/03/2018 03:48:04 PM Eastern Daylight Time	08/06/2018 01:47:03 AM Eastern Daylight Time	08/01/2018 08:33:58 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	008	7	2019	New York City Area	Kings	2	56659	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	009	0	1	01	01	H8432_009_0	6	1				08/03/2018	2019.01	08/03/2018 09:05:12 PM Eastern Daylight Time	08/06/2018 01:48:04 AM Eastern Daylight Time	08/01/2018 08:34:41 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	009	0	2019	Rockland and Westchester		2	87091	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	010	0	1	01	01	H8432_010_0	6	1				08/06/2018	2019.01	08/06/2018 01:56:55 PM Eastern Daylight Time	08/06/2018 01:49:04 AM Eastern Daylight Time	08/01/2018 08:35:25 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	010	0	2019	Nassau		2	78550	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	011	0	1	01	01	H8432_011_0	6	1				08/06/2018	2019.01	08/06/2018 01:57:08 PM Eastern Daylight Time	08/06/2018 01:50:04 AM Eastern Daylight Time	08/01/2018 08:36:07 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	011	0	2019	Suffolk		2	107007	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	012	0	1	01	01	H8432_012_0	4	1				05/30/2018	2019.01	05/30/2018 02:02:12 PM Eastern Daylight Time	07/16/2018 11:56:30 AM Eastern Daylight Time				07/16/2018 03:15:51 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Core (HMO)	01	01		1			H8432	012	0	2019	Select Counties in New York		2	5790	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8432	013	0	1	01	01	H8432_013_0	5	1				08/04/2018	2019.01	08/04/2018 10:43:33 AM Eastern Daylight Time	08/06/2018 01:52:05 AM Eastern Daylight Time	08/01/2018 08:36:49 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	013	0	2019	New York		2	27388	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	014	0	1	02	01	H8432_014_0	6	1				08/03/2018	2019.01	08/03/2018 09:06:20 PM Eastern Daylight Time	08/06/2018 09:13:24 AM Eastern Daylight Time	08/01/2018 08:37:33 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Choice (HMO-POS)	01	02		1			H8432	014	0	2019	Nassau		2	5285	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	015	0	1	02	01	H8432_015_0	5	1				08/03/2018	2019.01	08/03/2018 03:54:47 PM Eastern Daylight Time	08/06/2018 01:54:07 AM Eastern Daylight Time	08/01/2018 08:38:15 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Choice (HMO-POS)	01	02		1			H8432	015	0	2019	Kings		2	2163	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	016	0	1	01	01	H8432_016_0	6	1				08/03/2018	2019.01	08/03/2018 09:07:06 PM Eastern Daylight Time	08/06/2018 01:55:08 AM Eastern Daylight Time	08/01/2018 08:38:57 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	01	01		1			H8432	016	0	2019	Select Counties in New York		2	7765	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	017	0	1	01	01	H8432_017_0	6	1				08/03/2018	2019.01	08/03/2018 09:07:52 PM Eastern Daylight Time	08/06/2018 01:56:08 AM Eastern Daylight Time	08/01/2018 08:39:39 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	01	01		1			H8432	017	0	2019	Albany, Rensselaer, Schenectady, Saratoga		2	1728	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	018	0	1	01	01	H8432_018_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 01:58:59 PM Eastern Daylight Time	08/06/2018 08:57:13 AM Eastern Daylight Time	08/01/2018 08:26:49 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage (HMO SNP)	01	01		1			H8432	018	0	2019	Albany, Rensselaer, Schenectady, Dutchess, Putnam		2	4473	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(844)630-1023		(844)630-1023		(877)269-5706		(877)269-5706		(844)630-1024		(844)630-1024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	027	0	1	01	01	H8432_027_0	6	1				08/06/2018	2019.01	08/06/2018 12:31:20 PM Eastern Daylight Time	08/06/2018 01:58:09 AM Eastern Daylight Time	08/01/2018 08:40:22 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	01	01		1			H8432	027	0	2019	Select Counties in Lower New York		2	44547	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	028	0	1	01	01	H8432_028_0	7	1	2	1		08/10/2018	2019.01	08/10/2018 02:31:47 PM Eastern Daylight Time	08/10/2018 04:38:16 PM Eastern Daylight Time	08/01/2018 08:28:17 PM Eastern Daylight Time			08/10/2018 04:46:28 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage Select (HMO SNP)	01	01		1			H8432	028	0	2019	Select Counties in NY		2	22933	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(844)630-1023		(844)630-1023		(877)269-5706		(877)269-5706		(844)630-1024		(844)630-1024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	031	1	1	01	01	H8432_031_1	5	1				08/03/2018	2019.01	08/03/2018 04:42:59 PM Eastern Daylight Time	08/06/2018 02:00:09 AM Eastern Daylight Time	08/01/2018 08:41:05 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	01	01		1			H8432	031	1	2019	Select Counties in ME	Select Counties in ME	2	11090	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	031	2	1	01	01	H8432_031_2	6	1				08/03/2018	2019.01	08/03/2018 09:14:12 PM Eastern Daylight Time	08/06/2018 02:01:10 AM Eastern Daylight Time	08/01/2018 08:41:47 PM Eastern Daylight Time			08/06/2018 06:27:08 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	01	01		1			H8432	031	2	2019	Select Counties in ME	Penobscot and Somerset	2	3434	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	032	0	1	01	01	H8432_032_0	6	1				08/03/2018	2019.01	08/03/2018 03:50:58 PM Eastern Daylight Time	08/06/2018 02:02:10 AM Eastern Daylight Time	08/01/2018 08:42:30 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	01	01		1			H8432	032	0	2019	Nassau		2	8698	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	033	0	1	01	01	H8432_033_0	6	1				08/03/2018	2019.01	08/03/2018 03:50:43 PM Eastern Daylight Time	08/06/2018 02:03:11 AM Eastern Daylight Time	08/01/2018 08:43:12 PM Eastern Daylight Time			08/06/2018 06:38:00 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	01	01		1			H8432	033	0	2019	Suffolk		2	9899	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	801	0	1	01	01	H8432_801_0	2	1				06/19/2018	2019.01	06/19/2018 01:48:36 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	801	0	2019	Select Counties in Maine		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	802	0	1	01	01	H8432_802_0	2	1				06/19/2018	2019.01	06/19/2018 01:48:58 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	802	0	2019	Select Counties in Maine		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	803	0	2	01	01	H8432_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:49:28 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		2	1		H8432	803	0	2019	Maine - Select Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	804	0	1	01	01	H8432_804_0	2	1				06/19/2018	2019.01	06/19/2018 01:59:05 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	804	0	2019	New York - Select Counties		1	3357	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	805	0	1	01	01	H8432_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:59:14 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	805	0	2019	New York - Select Counties		1	3357	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	806	0	2	01	01	H8432_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:52:20 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		2	1		H8432	806	0	2019	New York - Select Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	807	0	2	01	01	H8432_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:52:54 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		2	1		H8432	807	0	2019	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	808	0	1	01	01	H8432_808_0	2	1				06/19/2018	2019.01	06/19/2018 02:00:08 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	808	0	2019	Select Maine counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	809	0	1	01	01	H8432_809_0	2	1				06/19/2018	2019.01	06/19/2018 02:00:16 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	809	0	2019	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	810	0	2	01	01	H8432_810_0	2	1				06/19/2018	2019.01	06/19/2018 02:00:24 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		2	1		H8432	810	0	2019	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	811	0	2	01	01	H8432_811_0	2	1				06/19/2018	2019.01	06/19/2018 02:01:06 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		2	1		H8432	811	0	2019	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	812	0	1	01	01	H8432_812_0	2	1				06/19/2018	2019.01	06/19/2018 02:01:23 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	812	0	2019	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	813	0	1	01	01	H8432_813_0	2	1				06/19/2018	2019.01	06/19/2018 02:02:33 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	813	0	2019	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	814	0	2	01	01	H8432_814_0	2	1				06/19/2018	2019.01	06/19/2018 02:02:26 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		2	1		H8432	814	0	2019	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	815	0	2	01	01	H8432_815_0	2	1				06/19/2018	2019.01	06/19/2018 02:03:02 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		2	1		H8432	815	0	2019	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	816	0	2	01	01	H8432_816_0	2	1				06/19/2018	2019.01	06/19/2018 02:04:10 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		2	1		H8432	816	0	2019	Select NY Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	817	0	1	01	01	H8432_817_0	2	1				06/19/2018	2019.01	06/19/2018 02:03:51 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	817	0	2019	Select NY counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(800)564-9053		(800)564-9053		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8452	001	0	1	48	05	H8452_001_0	9	1				08/27/2018	2019.01	08/27/2018 08:49:29 AM Eastern Daylight Time					08/27/2018 09:14:19 AM Eastern Daylight Time	CARESOURCE	CareSource MyCare Ohio	www.caresource.com/MyCare/	CareSource MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H8452	001	0	2019	Northeast, Northeast Central, East Central Ohio		2	318000	2			2						www.caresource.com	www.caresource.com/MyCare/	https://memberportal.caresource.com/App/OH/FindADoctor/MyCare	(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750																
H8457	001	0	1	01	01	H8457_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 10:00:13 AM Eastern Daylight Time	08/07/2018 02:52:16 PM Eastern Daylight Time	08/07/2018 02:52:16 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Longevity Health Plan (HMO SNP)	www.longevityhealthplan.com	Longevity Health Plan (HMO SNP)	01	01		1			H8457	001	0	2019	New York (partial)		2	2041	2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8490	001	0	1	48	05	H8490_001_0	4	1				07/17/2018	2019.01	07/17/2018 09:46:26 AM Eastern Daylight Time					07/17/2018 09:46:35 AM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE FIDA Complete	www.vnsnychoice.org	VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)	05	48		1			H8490	001	0	2019	Ki, Qu, Brx, NY, Ri,  and Na		2		2			2						www.vnsnychoice.org	www.vnsnychoice.org	www.vnsnychoice.org	(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8506	001	0	1	01	01	H8506_001_0	10	1				08/10/2018	2019.01	08/10/2018 12:06:38 PM Pacific Daylight Time	08/03/2018 02:29:50 PM Pacific Daylight Time	08/03/2018 02:29:48 PM Pacific Daylight Time			08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health HMO (HMO)	01	01		1			H8506	001	0	2019	Eastern Oregon		2	7788	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8506	002	0	1	01	01	H8506_002_0	8	1				08/10/2018	2019.01	08/10/2018 12:07:49 PM Pacific Daylight Time	08/03/2018 02:29:46 PM Pacific Daylight Time				08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health HMO Basic (HMO)	01	01		1			H8506	002	0	2019	Eastern Oregon		2	500	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8506	003	0	1	01	01	H8506_003_0	11	1				08/10/2018	2019.01	08/10/2018 12:08:23 PM Pacific Daylight Time	08/03/2018 02:29:43 PM Pacific Daylight Time	08/03/2018 02:28:56 PM Pacific Daylight Time			08/10/2018 12:37:34 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health HMO Enhanced + RX (HMO)	01	01		1			H8506	003	0	2019	Eastern Oregon		2	300	2			2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8552	020	0	1	04	01	H8552_020_0	10	1				08/08/2018	2019.01	08/08/2018 01:07:37 PM Pacific Daylight Time	08/08/2018 01:06:32 PM Pacific Daylight Time	08/01/2018 05:43:55 PM Pacific Daylight Time			08/08/2018 01:08:57 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue Access (PPO)	01	04		1			H8552	020	0	2019	Orange County		2	32579	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(844)364-2129		(844)364-2129		(877)811-3107		(877)811-3107		(844)364-2124		(844)364-2124		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	028	0	1	04	01	H8552_028_0	8	1		1		08/03/2018	2019.01	08/03/2018 11:56:59 AM Pacific Daylight Time		08/01/2018 05:44:37 PM Pacific Daylight Time		08/05/2018 11:04:43 PM Pacific Daylight Time	08/06/2018 04:40:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue ESRD (PPO SNP)	01	04		1			H8552	028	0	2019	Select Counties in California		2	11032	2			1	4			00000000100000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(844)648-9540		(844)648-9540		(844)788-9044		(844)788-9044		(844)648-9540		(844)648-9540		(844)788-9045		(844)788-9045		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	801	0	1	04	01	H8552_801_0	2	1				06/19/2018	2019.01	06/19/2018 01:18:42 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	801	0	2019	California		1	50904	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	802	0	1	04	01	H8552_802_0	2	1				06/19/2018	2019.01	06/19/2018 01:19:13 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	802	0	2019	California		1	189066	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	803	0	1	04	01	H8552_803_0	2	1				06/19/2018	2019.01	06/19/2018 01:19:29 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	803	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	805	0	2	04	01	H8552_805_0	2	1				06/19/2018	2019.01	06/19/2018 01:19:43 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	805	0	2019	National		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(877)411-1647		(877)411-1647		(833)848-8730		(833)848-8730		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	806	0	1	04	01	H8552_806_0	2	1				06/19/2018	2019.01	06/19/2018 01:20:02 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	806	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	807	0	2	04	01	H8552_807_0	2	1				06/19/2018	2019.01	06/19/2018 01:20:13 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	807	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	808	0	2	04	01	H8552_808_0	2	1				06/19/2018	2019.01	06/19/2018 01:20:29 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	808	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	809	0	2	04	01	H8552_809_0	2	1				06/19/2018	2019.01	06/19/2018 01:20:44 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	809	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	810	0	1	04	01	H8552_810_0	2	1				06/19/2018	2019.01	06/19/2018 01:20:57 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	810	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	811	0	1	04	01	H8552_811_0	2	1				06/19/2018	2019.01	06/19/2018 01:21:09 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	811	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	812	0	1	04	01	H8552_812_0	2	1				06/19/2018	2019.01	06/19/2018 01:21:19 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	812	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	813	0	1	04	01	H8552_813_0	2	1				06/19/2018	2019.01	06/19/2018 01:21:31 PM Pacific Daylight Time					06/19/2018 01:22:56 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	01	04		1			H8552	813	0	2019	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8554	001	0	1	01	01	H8554_001_0	7	1				07/09/2018	2019.01	07/09/2018 12:22:40 PM Central Daylight Time	08/06/2018 12:58:19 PM Central Daylight Time	08/01/2018 12:01:53 PM Central Daylight Time			08/07/2018 01:30:54 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H8554	001	0	2019	State of Texas		2	15402	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	001	0	1	01	01	H8578_001_0	7	1				07/25/2018	2019.01	07/25/2018 01:50:01 PM Eastern Daylight Time	08/03/2018 03:35:43 PM Eastern Daylight Time	08/03/2018 03:35:43 PM Eastern Daylight Time			08/03/2018 03:37:53 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Premium (HMO)	01	01		1			H8578	001	0	2019	Hampden, Hampshire, Franklin, Berkshire Counties		2	38681	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	003	0	1	01	01	H8578_003_0	5	1				07/11/2018	2019.01	07/11/2018 07:13:22 PM Eastern Daylight Time	06/18/2018 01:23:47 PM Eastern Daylight Time				07/11/2018 07:36:56 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Premium No Rx (HMO)	01	01		1			H8578	003	0	2019	Hampden, Hampshire, Franklin, Berkshire Counties		2	1939	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8578	004	0	1	01	01	H8578_004_0	7	1				07/12/2018	2019.01	07/12/2018 09:56:59 AM Eastern Daylight Time	08/03/2018 03:35:43 PM Eastern Daylight Time	08/03/2018 03:35:44 PM Eastern Daylight Time			08/03/2018 03:37:53 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Plus (HMO)	01	01		1			H8578	004	0	2019	Hampden, Hampshire, Franklin, Berkshire Counties		2	45561	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	009	0	1	01	01	H8578_009_0	5	1				07/11/2018	2019.01	07/11/2018 05:56:24 PM Eastern Daylight Time	06/18/2018 01:25:57 PM Eastern Daylight Time				07/11/2018 07:36:56 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Basic No Rx (HMO)	01	01		1			H8578	009	0	2019	Hampden, Hampshire, Franklin, Berkshire Counties		2	2080	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8578	012	0	1	01	01	H8578_012_0	7	1				07/12/2018	2019.01	07/12/2018 09:57:29 AM Eastern Daylight Time	08/03/2018 03:35:44 PM Eastern Daylight Time	08/03/2018 03:35:41 PM Eastern Daylight Time			08/03/2018 03:37:53 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Value (HMO)	01	01		1			H8578	012	0	2019	Hampden, Hampshire, Franklin, Berkshire Counties		2	16834	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	016	0	1	02	01	H8578_016_0	7	1				07/12/2018	2019.01	07/12/2018 09:58:44 AM Eastern Daylight Time	08/03/2018 03:35:42 PM Eastern Daylight Time	08/03/2018 03:35:42 PM Eastern Daylight Time			08/03/2018 03:37:53 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Select (HMO-POS)	01	02		1			H8578	016	0	2019	Hampden, Hampshire, Franklin, Berkshire Counties		2	1200	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	801	0	1	02	01	H8578_801_0	3	1				05/30/2018	2019.01	05/30/2018 06:55:18 PM Eastern Daylight Time					06/03/2018 12:02:24 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Employer Group RX (HMO-POS)	01	02		1			H8578	801	0	2019	United States		1	72	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;15;	2		1				
H8578	802	0	1	02	01	H8578_802_0	3	1				05/30/2018	2019.01	05/30/2018 06:57:01 PM Eastern Daylight Time					06/03/2018 12:02:24 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	HNE Medicare Employer Group Calendar (HMO-POS)	01	02		1			H8578	802	0	2019	United States		1	72	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(711)-		(711)-		(711)-		(711)-										1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;15;	2		1				
H8578	803	0	1	02	01	H8578_803_0	3	1				05/30/2018	2019.01	05/30/2018 06:58:19 PM Eastern Daylight Time					06/03/2018 12:02:24 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	HNE Medicare Employer Group Non-Calendar (HMO-POS)	01	02		1			H8578	803	0	2019	United States		1	72	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;15;	2		1				
H8597	001	0	1	01	01	H8597_001_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 04:34:18 PM Eastern Daylight Time	08/02/2018 04:28:13 PM Eastern Daylight Time	08/01/2018 12:07:24 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnabetterhealth.com/texas-hmosnp	Aetna Medicare Dual Core (HMO SNP)	01	01		1			H8597	001	0	2019	Bexar and Guadalupe counties		2		2			1	3		1		1	www.aetnabetterhealth.com/texas-hmosnp	www.aetnabetterhealth.com/texas-hmosnp	www.aetnabetterhealth.com/texas-hmosnp	(800)371-8614		(800)371-8614		(855)338-7027		(855)338-7027		(800)371-8614		(800)371-8614		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8597	002	0	1	01	01	H8597_002_0	2	1	2	1		05/30/2018	2019.01	05/30/2018 04:34:48 PM Eastern Daylight Time	08/02/2018 04:28:58 PM Eastern Daylight Time	08/01/2018 12:08:20 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnabetterhealth.com/texas-hmosnp	Aetna Medicare Dual Core (HMO SNP)	01	01		1			H8597	002	0	2019	Johnson and Tarrant counties		2		2			1	3		1		1	www.aetnabetterhealth.com/texas-hmosnp	www.aetnabetterhealth.com/texas-hmosnp	www.aetnabetterhealth.com/texas-hmosnp	(800)371-8614		(800)371-8614		(855)338-7027		(855)338-7027		(800)371-8614		(800)371-8614		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8604	010	0	1	04	01	H8604_010_0	4	1				06/01/2018	2019.01	06/01/2018 09:49:30 AM Eastern Daylight Time	08/02/2018 12:41:54 PM Eastern Daylight Time	07/31/2018 04:51:07 PM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice - Option II (PPO)	01	04		1			H8604	010	0	2019	East Central OH		2	4000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8604	011	0	1	04	01	H8604_011_0	4	1				06/01/2018	2019.01	06/01/2018 09:50:19 AM Eastern Daylight Time	08/02/2018 12:45:26 PM Eastern Daylight Time	08/01/2018 10:17:43 AM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice - Option II (PPO)	01	04		1			H8604	011	0	2019	Southeastern OH, West Virginia		2	12000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8604	013	0	1	04	01	H8604_013_0	4	1				06/01/2018	2019.01	06/01/2018 09:51:17 AM Eastern Daylight Time	08/02/2018 12:47:11 PM Eastern Daylight Time	07/31/2018 04:52:43 PM Eastern Daylight Time			08/02/2018 12:54:57 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice Capitol Plan (PPO)	01	04		1			H8604	013	0	2019	Kanawha and Surrounding Counties		2	3500	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8604	801	0	1	04	01	H8604_801_0	3	1				05/31/2018	2019.01	05/31/2018 01:16:02 PM Eastern Daylight Time					06/04/2018 12:32:45 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice - Employer (PPO)	01	04		1			H8604	801	0	2019	Eastern Ohio and West Virginia, National		1	500	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	002	0	1	04	01	H8634_002_0	7	1				07/09/2018	2019.01	07/09/2018 09:23:12 AM Mountain Daylight Time	08/06/2018 11:59:04 AM Mountain Daylight Time	08/01/2018 11:02:38 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	002	0	2019	Benalillo, Sandoval Torrance and Valencia counties		2	17583	2			2						www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	www.getbluenm.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	003	0	1	04	01	H8634_003_0	7	1				07/09/2018	2019.01	07/09/2018 09:23:23 AM Mountain Daylight Time	08/06/2018 11:59:51 AM Mountain Daylight Time	08/01/2018 11:03:23 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	003	0	2019	Chicago Metro Area		2	77766	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	004	0	1	04	01	H8634_004_0	7	1				07/09/2018	2019.01	07/09/2018 09:23:34 AM Mountain Daylight Time	08/06/2018 12:00:38 PM Mountain Daylight Time	08/01/2018 11:04:07 AM Mountain Daylight Time			08/07/2018 08:24:03 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H8634	004	0	2019	Chicago Metro Area		2	66904	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	801	0	1	04	01	H8634_801_0	2	1				06/18/2018	2019.01	06/18/2018 01:59:11 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	801	0	2019	State of New Mexico		1	2382	2			2						www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	803	0	1	04	01	H8634_803_0	2	1				06/18/2018	2019.01	06/18/2018 01:59:40 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	803	0	2019	State of New Mexico		1	1	2			2						www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	805	0	1	04	01	H8634_805_0	2	1				06/18/2018	2019.01	06/18/2018 02:00:38 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	805	0	2019	State of New Mexico		1	1	2			2						www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	807	0	1	04	01	H8634_807_0	2	1				06/18/2018	2019.01	06/18/2018 02:04:23 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	807	0	2019	State of Oklahoma		1	1046	2			2						www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	809	0	1	04	01	H8634_809_0	2	1				06/18/2018	2019.01	06/18/2018 02:04:49 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	809	0	2019	State of Oklahoma		1	1	2			2						www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	811	0	1	04	01	H8634_811_0	2	1				06/18/2018	2019.01	06/18/2018 02:05:10 PM Central Daylight Time					06/18/2018 02:06:49 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	811	0	2019	State of Oklahoma		1	1	2			2						www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	813	0	1	04	01	H8634_813_0	2	1				06/18/2018	2019.01	06/18/2018 02:01:45 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	813	0	2019	State of Illinois		1	42585	2			2						www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	815	0	1	04	01	H8634_815_0	2	1				06/18/2018	2019.01	06/18/2018 02:02:18 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	815	0	2019	State of Illinois		1	91506	2			2						www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	817	0	1	04	01	H8634_817_0	2	1				06/18/2018	2019.01	06/18/2018 02:02:31 PM Mountain Daylight Time					06/18/2018 02:04:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	817	0	2019	State of Illinois		1	2	2			2						www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8649	003	0	1	01	01	H8649_003_0	3	1				08/02/2018	2019.01	08/02/2018 06:14:14 AM Central Daylight Time	08/02/2018 02:05:10 PM Eastern Daylight Time	07/31/2018 06:36:43 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF UTAH, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Advantra (HMO)	01	01		1			H8649	003	0	2019	Northern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	008	0	1	01	01	H8649_008_0	2	1				08/02/2018	2019.01	08/02/2018 06:14:41 AM Central Daylight Time	08/02/2018 02:05:47 PM Eastern Daylight Time	07/31/2018 06:37:24 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	AETNA HEALTH OF UTAH, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Advantra Select (HMO)	01	01		1			H8649	008	0	2019	UT- Uintah, Duchesne / WY-Uinta		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	801	0	1	01	01	H8649_801_0	2	1				06/04/2018	2019.01	06/04/2018 11:51:58 AM Eastern Daylight Time					06/04/2018 12:08:36 PM Eastern Daylight Time	AETNA HEALTH OF UTAH, INC	Altius Health Plans	www.altiusadvantra.com	Altius Advantra Emp Calendar Year (HMO)	01	01		1			H8649	801	0	2019	State of Utah		1	120	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559		(844)741-8423		(844)741-8423		(855)338-9559		(855)338-9559		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H8649	803	0	1	01	01	H8649_803_0	2	1				06/04/2018	2019.01	06/04/2018 11:52:50 AM Eastern Daylight Time					06/04/2018 12:08:36 PM Eastern Daylight Time	AETNA HEALTH OF UTAH, INC	Altius Health Plans	www.altiusadvantra.com	Altius Advantra Emp MA Only (HMO)	01	01		1			H8649	803	0	2019	State of Utah		1	120	2			2						www.coventry-medicare.com/findpharmacy	www.coventry-medicare.com/group-formulary	www.coventry-medicare.com/findprovider	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;7b;7c;7d;7f;7g;7i;8a;14d;14e2;18a;	1					1				
H8655	004	0	1	20	08	H8655_004_0	1	1				05/31/2018	2019.01	05/31/2018 08:16:44 PM Eastern Daylight Time		05/31/2018 08:07:02 PM Eastern Daylight Time			05/31/2018 08:21:44 PM Eastern Daylight Time	RIVERSIDE RETIREMENT SERVICES, INC.	Riverside PACE	www.riversideonline.com	Riverside PACE Dual (PACE)	08	20		1			H8655	004	0	2019	Riverside PACE Dual		2		2			2						www.riversideonline.com	N/A - no formulary										(800)675-6368		(757)234-8104		(800)675-6368		(757)234-8104										(800)675-6368		(757)234-8104		(800)675-6368		(757)234-8104																
H8655	005	0	1	20	08	H8655_005_0	1	1				05/31/2018	2019.01	05/31/2018 08:16:54 PM Eastern Daylight Time		05/31/2018 08:06:51 PM Eastern Daylight Time			05/31/2018 08:21:44 PM Eastern Daylight Time	RIVERSIDE RETIREMENT SERVICES, INC.	Riverside PACE	www.riversideonline.com	Riverside PACE Medicare ONLY (PACE)	08	20		1			H8655	005	0	2019	Riverside PACE Medicare ONLY		2		2			2						www.riversideonline.com	N/A - no formulary										(800)675-6368		(757)234-8104		(800)675-6368		(757)234-8104										(800)675-6368		(757)234-8104		(800)675-6368		(757)234-8104																
H8677	001	0	1	48	05	H8677_001_0	2	1				07/06/2018	2019.01	07/06/2018 04:28:10 PM Pacific Daylight Time					07/06/2018 05:10:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8677	001	0	2019	Southern California		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8677	002	0	1	48	05	H8677_002_0	2	1				07/06/2018	2019.01	07/06/2018 04:11:48 PM Pacific Daylight Time					07/06/2018 05:10:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8677	002	0	2019	Los Angeles County		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8748	002	0	1	01	01	H8748_002_0	3	1				08/02/2018	2019.01	08/02/2018 02:55:03 PM Central Daylight Time	08/03/2018 09:36:22 AM Central Daylight Time	07/31/2018 07:57:00 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H8748	002	0	2019	Greenville and Pickens counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	008	0	1	02	01	H8748_008_0	3	1				08/02/2018	2019.01	08/02/2018 01:07:33 PM Central Daylight Time	08/03/2018 09:23:51 AM Central Daylight Time	07/31/2018 07:57:22 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 1 (HMO-POS)	01	02		1			H8748	008	0	2019	Gainesville Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	009	0	1	02	01	H8748_009_0	3	1				07/12/2018	2019.01	07/12/2018 06:41:30 PM Central Daylight Time	08/03/2018 09:24:22 AM Central Daylight Time	07/31/2018 07:57:46 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 2 (HMO-POS)	01	02		1			H8748	009	0	2019	Gainesville Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	010	0	1	02	01	H8748_010_0	3	1				07/12/2018	2019.01	07/12/2018 06:41:43 PM Central Daylight Time	08/03/2018 09:24:53 AM Central Daylight Time	07/31/2018 07:58:08 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 1 (HMO-POS)	01	02		1			H8748	010	0	2019	Central Georgia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	011	0	1	02	01	H8748_011_0	3	1				07/12/2018	2019.01	07/12/2018 04:00:32 PM Central Daylight Time	08/03/2018 09:25:25 AM Central Daylight Time	07/31/2018 07:58:32 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 2 (HMO-POS)	01	02		1			H8748	011	0	2019	Central Georgia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	012	0	1	01	01	H8748_012_0	3	1				08/02/2018	2019.01	08/02/2018 02:55:33 PM Central Daylight Time	08/03/2018 09:25:57 AM Central Daylight Time	07/31/2018 07:58:54 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	012	0	2019	Spartanburg County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	013	0	1	01	01	H8748_013_0	3	1				07/13/2018	2019.01	07/13/2018 07:51:24 AM Central Daylight Time	08/03/2018 09:26:29 AM Central Daylight Time	07/31/2018 07:59:18 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	013	0	2019	Lancaster and York Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;	
H8748	014	0	1	01	01	H8748_014_0	3	1				07/13/2018	2019.01	07/13/2018 08:26:10 AM Central Daylight Time	08/03/2018 09:26:59 AM Central Daylight Time	07/31/2018 07:59:40 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	014	0	2019	Beaufort and Colleton Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	015	0	1	01	01	H8748_015_0	3	1				08/02/2018	2019.01	08/02/2018 02:55:55 PM Central Daylight Time	08/03/2018 09:27:31 AM Central Daylight Time	07/31/2018 08:00:04 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	015	0	2019	Charleston, Berkeley and Dorchester Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	017	0	1	01	01	H8748_017_0	3	1				07/13/2018	2019.01	07/13/2018 07:53:01 AM Central Daylight Time	08/03/2018 09:28:02 AM Central Daylight Time	07/31/2018 08:00:26 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	017	0	2019	Clarendon, Orangeburg and Sumter County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	018	0	1	01	01	H8748_018_0	3	1				07/13/2018	2019.01	07/13/2018 07:53:28 AM Central Daylight Time	08/03/2018 09:28:33 AM Central Daylight Time	07/31/2018 08:00:50 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	018	0	2019	Central South Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	019	0	1	01	01	H8748_019_0	2	1				07/13/2018	2019.01	07/13/2018 07:53:46 AM Central Daylight Time	06/01/2018 03:57:09 PM Central Daylight Time				07/13/2018 10:27:46 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H8748	019	0	2019	Select Counties in South Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8748	020	0	1	01	01	H8748_020_0	4	1				07/13/2018	2019.01	07/13/2018 07:54:06 AM Central Daylight Time	08/03/2018 09:29:36 AM Central Daylight Time	07/31/2018 08:01:16 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	020	0	2019	Georgetown, Horry and Williamsburg Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	022	0	1	02	01	H8748_022_0	4	1				07/12/2018	2019.01	07/12/2018 03:58:05 PM Central Daylight Time	08/03/2018 09:30:08 AM Central Daylight Time	07/31/2018 08:01:40 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 1 (HMO-POS)	01	02		1			H8748	022	0	2019	Bryan and Effingham counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	023	0	1	02	01	H8748_023_0	4	1				06/28/2018	2019.01	06/28/2018 10:27:12 AM Central Daylight Time	08/03/2018 09:30:39 AM Central Daylight Time	07/31/2018 08:02:02 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 2 (HMO-POS)	01	02		1			H8748	023	0	2019	Bryan and Effingham counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	024	0	1	01	01	H8748_024_0	3	1				08/02/2018	2019.01	08/02/2018 03:18:33 PM Central Daylight Time	08/03/2018 09:31:10 AM Central Daylight Time	07/31/2018 08:02:28 PM Central Daylight Time			08/06/2018 09:38:09 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H8748	024	0	2019	Greenville South Carolina		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8764	001	0	1	01	01	H8764_001_0	11	1				07/25/2018	2019.01	07/25/2018 01:55:48 PM Pacific Daylight Time	08/03/2018 04:25:08 PM Pacific Daylight Time	08/03/2018 04:25:12 PM Pacific Daylight Time			08/03/2018 04:32:49 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage (HMO)	01	01		1			H8764	001	0	2019	Monterey County		2		2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8764	002	0	1	02	01	H8764_002_0	11	1				07/25/2018	2019.01	07/25/2018 01:56:37 PM Pacific Daylight Time	08/03/2018 04:25:13 PM Pacific Daylight Time	08/03/2018 04:25:14 PM Pacific Daylight Time			08/03/2018 04:32:49 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Plus (HMO-POS)	01	02		1			H8764	002	0	2019	Monterey County		2		2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8764	003	0	1	01	01	H8764_003_0	11	1				07/25/2018	2019.01	07/25/2018 01:57:15 PM Pacific Daylight Time	08/03/2018 04:25:16 PM Pacific Daylight Time	08/03/2018 04:25:17 PM Pacific Daylight Time			08/03/2018 04:32:49 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Value (HMO)	01	01		1			H8764	003	0	2019	Monterey County		2		2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8764	801	0	1	02	01	H8764_801_0	4	1				06/04/2018	2019.01	06/04/2018 07:00:44 PM Pacific Daylight Time					06/04/2018 07:23:39 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Group Plus (HMO-POS)	01	02		1			H8764	801	0	2019	Monterey County		1	3000	2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8768	001	0	1	04	01	H8768_001_0	4	1				08/02/2018	2019.01	08/02/2018 03:51:31 PM Central Daylight Time	08/03/2018 10:27:28 AM Central Daylight Time	07/31/2018 08:02:50 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	001	0	2019	Select counties in Iowa and Illinois		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	002	0	1	04	01	H8768_002_0	4	1				08/02/2018	2019.01	08/02/2018 03:53:17 PM Central Daylight Time	08/03/2018 10:28:00 AM Central Daylight Time	07/31/2018 08:03:14 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	002	0	2019	Select counties in Iowa		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	003	0	1	04	01	H8768_003_0	4	1				07/12/2018	2019.01	07/12/2018 11:55:29 AM Central Daylight Time	08/03/2018 10:28:32 AM Central Daylight Time	07/31/2018 08:03:40 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	003	0	2019	Northwestern Illinois		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	004	0	1	04	01	H8768_004_0	4	1				07/12/2018	2019.01	07/12/2018 11:55:46 AM Central Daylight Time	08/03/2018 10:29:03 AM Central Daylight Time	07/31/2018 08:04:14 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	004	0	2019	Boone and Winnebago counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	005	0	1	04	01	H8768_005_0	4	1				07/12/2018	2019.01	07/12/2018 11:56:02 AM Central Daylight Time	08/03/2018 10:29:34 AM Central Daylight Time	07/31/2018 08:04:38 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	005	0	2019	Cook, Kane, and Will Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	006	0	1	04	01	H8768_006_0	4	1				07/12/2018	2019.01	07/12/2018 11:56:47 AM Central Daylight Time	08/03/2018 10:30:05 AM Central Daylight Time	07/31/2018 08:05:02 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	006	0	2019	Lucas and Wood Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	007	0	1	04	01	H8768_007_0	4	1				07/12/2018	2019.01	07/12/2018 11:57:08 AM Central Daylight Time	08/03/2018 10:30:37 AM Central Daylight Time	07/31/2018 08:05:26 PM Central Daylight Time			08/06/2018 09:29:39 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	007	0	2019	Central Ohio		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	008	0	1	04	01	H8768_008_0	3	1				05/31/2018	2019.01	05/31/2018 02:12:57 PM Central Daylight Time	08/03/2018 10:31:09 AM Central Daylight Time	07/31/2018 08:05:52 PM Central Daylight Time			08/06/2018 09:47:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	008	0	2019	Oklahoma City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	009	0	1	04	01	H8768_009_0	3	1				05/29/2018	2019.01	05/29/2018 11:03:57 AM Central Daylight Time	08/03/2018 10:31:42 AM Central Daylight Time	07/31/2018 08:06:16 PM Central Daylight Time			08/06/2018 09:47:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H8768	009	0	2019	Tulsa Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8769	001	0	1	20	08	H8769_001_0	1	1				05/30/2018	2019.01	05/30/2018 03:32:01 PM Central Daylight Time		05/30/2018 02:24:53 PM Central Daylight Time			05/30/2018 03:33:29 PM Central Daylight Time	GENESYS REGIONAL MEDICAL CENTER, INC.	Genesys PACE of Genesee County	https://healthcare.ascension.org/Locations	Genesys PACE of Genesee County (PACE)	08	20		1			H8769	001	0	2019	Genesee County		2		2			2						genesys.org/PACE	genesys.org/PACE												(810)236-7500				(810)236-7500												(810)236-7554				(810)236-7554																
H8769	002	0	1	20	08	H8769_002_0	1	1				05/30/2018	2019.01	05/30/2018 03:32:31 PM Central Daylight Time		05/30/2018 02:24:54 PM Central Daylight Time			05/30/2018 03:33:29 PM Central Daylight Time	GENESYS REGIONAL MEDICAL CENTER, INC.	Genesys PACE of Genesee County	https://healthcare.ascension.org/Locations	Genesys PACE of Genesee County (PACE)	08	20		1			H8769	002	0	2019	Genesee County		2		2			2						genesys.org/PACE	genesys.org/PACE												(810)236-7500				(810)236-7500												(810)236-7554				(810)236-7554																
H8777	001	0	1	20	08	H8777_001_0	1	1				06/01/2018	2019.01	06/01/2018 01:07:23 PM Eastern Daylight Time		05/30/2018 04:16:49 PM Eastern Daylight Time			06/01/2018 01:09:55 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	completeseniorcare.org	Complete Senior Care Dual (PACE)	08	20		1			H8777	001	0	2019	Niagara, NY		2		2			2						Pharmastar	Pharmastar										(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220									(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220															
H8777	002	0	1	20	08	H8777_002_0	1	1				06/01/2018	2019.01	06/01/2018 01:08:09 PM Eastern Daylight Time		05/30/2018 04:16:31 PM Eastern Daylight Time			06/01/2018 01:09:55 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	completeseniorcare.org	Complete Senior Care Medicare Only (PACE)	08	20		1			H8777	002	0	2019	Niagara, NY		2		2			2						Pharmastar	Pharmastar										(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220									(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220															
H8783	001	0	1	04	01	H8783_001_0	6	1				08/07/2018	2019.01	08/07/2018 12:29:21 PM Central Daylight Time	08/07/2018 09:44:37 AM Central Daylight Time	08/02/2018 04:19:41 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	essentiacare.org	EssentiaCare Secure (PPO)	01	04		1			H8783	001	0	2019	Northern Minnesota and Wisconsin: 13 Counties		2		2			2						essentiacare.org	essentiacare.org	home.ucare.org/en-us/search-network	(855)432-7025		(218)722-4915		(855)432-7027		(218)722-4783		(855)432-7025		(218)722-4915		(855)432-7027		(218)722-4783		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2						2			
H8783	002	0	1	04	01	H8783_002_0	5	1				08/07/2018	2019.01	08/07/2018 12:35:43 PM Central Daylight Time	08/07/2018 09:46:36 AM Central Daylight Time	08/02/2018 04:20:36 PM Central Daylight Time			08/07/2018 01:47:53 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	essentiacare.org	EssentiaCare Grand (PPO)	01	04		1			H8783	002	0	2019	Northern Minnesota and Wisconsin: 13 Counties		2		2			2						essentiacare.org	essentiacare.org	home.ucare.org/en-us/search-network	(855)432-7025		(218)722-4915		(855)432-7027		(218)722-4783		(855)432-7025		(218)722-4915		(855)432-7027		(218)722-4783		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2						2			
H8786	001	0	1	48	05	H8786_001_0	4	1				08/23/2018	2019.01	08/23/2018 10:58:26 AM Central Daylight Time					08/23/2018 10:59:09 AM Central Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup STAR+PLUS MMP	www.myamerigroup.com/txmmp	Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan)	05	48		1			H8786	001	0	2019	Select TX Service Areas		2	169773	2			2						www.myamerigroup/medicare.com	www.myamerigroup.com/txmmp	www.myamerigroup.com/txmmp	(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8800	001	0	1	20	08	H8800_001_0	1	1				05/23/2018	2019.01	05/23/2018 12:18:30 PM Eastern Daylight Time		05/23/2018 12:01:43 PM Eastern Daylight Time			05/23/2018 12:20:02 PM Eastern Daylight Time	TOTAL SENIOR CARE, INC.	Total Senior Care, Inc.	www.totalseniorcare.org	Total Senior Care - Dual (PACE)	08	20		1			H8800	001	0	2019	Cattaraugus, Allegany and Chautauqua counties		2		2			2						totalseniorcare.org	www.totalseniorcare.org	www.totalseniorcare.org									(866)939-8613		(716)379-8474		(866)939-8613		(716)379-8474										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
H8800	002	0	1	20	08	H8800_002_0	1	1				05/23/2018	2019.01	05/23/2018 12:18:47 PM Eastern Daylight Time		05/23/2018 12:01:45 PM Eastern Daylight Time			05/23/2018 12:20:02 PM Eastern Daylight Time	TOTAL SENIOR CARE, INC.	Total Senior Care, Inc.	www.totalseniorcare.org	Total Senior Care - Medicare Small Only (PACE)	08	20		1			H8800	002	0	2019	Cattaraugus, Allegany and Chautauqua counties		2		2			2						totalseniorcare.org	www.totalseniorcare.org	www.totalseniorcare.org									(866)939-8613		(716)379-8474		(866)939-8613		(716)379-8474										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
H8851	001	0	1	48	05	H8851_001_0	4	1				07/16/2018	2019.01	07/16/2018 12:06:31 PM Eastern Daylight Time					07/16/2018 12:12:24 PM Eastern Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	SWH Whole Health FIDA Plan	www.seniorwholehealth.com	SWH Whole Health FIDA (Medicare-Medicaid Plan)	05	48		1			H8851	001	0	2019	Kings, Queens, Bronx, and New York Counties		2	1680	2			2						www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(844)861-3432		(844)861-3432		(844)861-3432		(844)861-3432		(844)861-3432		(844)861-3432		(844)861-3432		(844)861-3432		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8854	002	0	1	01	01	H8854_002_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 02:06:33 PM Eastern Daylight Time	08/07/2018 01:56:31 PM Eastern Daylight Time	08/07/2018 01:56:32 PM Eastern Daylight Time			08/07/2018 02:07:42 PM Eastern Daylight Time	UNIVERSITY OF MARYLAND HEALTH ADVANTAGE, INC.	University of Maryland Health Advantage	www.UMMedicareAdvantage.org	UMHA Dual (HMO SNP)	01	01		1			H8854	002	0	2019	Central Maryland and Select Eastern Shore counties		2	69756	2			1	3		2		1	www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	(844)386-6762		(410)779-9932		(844)262-1122		(844)262-1122		(844)786-6762		(844)786-6762		(844)262-1122		(844)262-1122		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8889	001	0	1	04	01	H8889_001_0	7	1				07/18/2018	2019.01	07/18/2018 03:43:18 PM Central Daylight Time	08/02/2018 01:49:34 PM Central Daylight Time	08/01/2018 08:39:12 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica Advantage Solution H8889-001 (PPO)	01	04		1			H8889	001	0	2019	Minneapolis/St. Paul Metro Area		2	202146	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	002	0	1	04	01	H8889_002_0	6	1				07/18/2018	2019.01	07/18/2018 03:58:16 PM Central Daylight Time	08/02/2018 01:51:17 PM Central Daylight Time	08/01/2018 08:39:46 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica Advantage Solution H8889-002 (PPO)	01	04		1			H8889	002	0	2019	Select Counties in MN		2	42875	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	003	0	1	04	01	H8889_003_0	6	1				07/18/2018	2019.01	07/18/2018 03:53:01 PM Central Daylight Time	08/02/2018 01:52:05 PM Central Daylight Time	08/01/2018 08:40:21 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica Advantage Solution H8889-003 (PPO)	01	04		1			H8889	003	0	2019	Minneapolis/St. Paul Metro Area		2	71094	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	004	0	1	04	01	H8889_004_0	6	1				07/18/2018	2019.01	07/18/2018 04:05:13 PM Central Daylight Time	08/02/2018 01:52:56 PM Central Daylight Time	08/01/2018 08:40:57 AM Central Daylight Time			08/03/2018 02:40:45 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica Advantage Solution H8889-004 (PPO)	01	04		1			H8889	004	0	2019	Southern Minnesota		2	30150	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	801	0	1	04	01	H8889_801_0	4	1				05/25/2018	2019.01	05/25/2018 10:13:34 AM Central Daylight Time					05/31/2018 04:47:20 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica Group Advantage Solution (PPO)	01	04		1			H8889	801	0	2019	Select Counties in MN		1	36000	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)575-2330		(952)992-2330		(866)269-6804		(952)992-2134		(800)575-2330		(952)992-2330		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8908	001	0	1	01	01	H8908_001_0	3	1				07/02/2018	2019.01	07/02/2018 05:53:27 PM Eastern Daylight Time	06/01/2018 01:05:49 PM Eastern Daylight Time	08/03/2018 09:21:24 AM Eastern Daylight Time			08/06/2018 10:50:53 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H8908-001 (HMO)	01	01		1			H8908	001	0	2019	Detroit area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	002	0	1	01	01	H8908_002_0	4	1				07/18/2018	2019.01	07/18/2018 05:34:20 PM Eastern Daylight Time	06/01/2018 01:15:11 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:50:53 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H8908-002 (HMO)	01	01		1			H8908	002	0	2019	Grand Rapids area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	004	0	1	01	01	H8908_004_0	4	1				07/18/2018	2019.01	07/18/2018 05:33:13 PM Eastern Daylight Time	08/03/2018 01:40:53 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:50:53 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H8908-004 (HMO)	01	01		1			H8908	004	0	2019	Detroit area		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	005	0	1	01	01	H8908_005_0	4	1	2	1		07/18/2018	2019.01	07/18/2018 09:48:20 AM Eastern Daylight Time	06/01/2018 01:28:19 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H8908-005 (HMO SNP)	01	01		1			H8908	005	0	2019	Select counties in Michigan		2		2			1	3		1		1	http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	801	0	1	01	01	H8908_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:47:33 PM Eastern Daylight Time					05/31/2018 01:46:43 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	801	0	2019	Select Counties in Michigan		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H8908	802	0	1	01	01	H8908_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:48:27 PM Eastern Daylight Time					05/31/2018 01:46:43 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	802	0	2019	Select Counties in Michigan		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H8967	001	0	1	01	01	H8967_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:05:08 AM Eastern Daylight Time	08/07/2018 02:52:16 PM Eastern Daylight Time	08/07/2018 02:52:16 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF NORTH DAKOTA, LLC	Great Plains Medicare Advantage (HMO SNP)	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO SNP)	01	01		1			H8967	001	0	2019	North Dakota (partial)		2	2072	2			1	1	1				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	013	0	1	02	01	H9001_013_0	4	1			1	08/07/2018	2019.01	08/07/2018 05:15:43 PM Eastern Daylight Time	08/07/2018 04:46:18 PM Eastern Daylight Time	08/07/2018 05:10:21 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO-POS)	01	02		1			H9001	013	0	2019	Worcester and Franklin counties		2	41822	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	015	0	1	01	01	H9001_015_0	4	1			1	08/07/2018	2019.01	08/07/2018 05:15:48 PM Eastern Daylight Time	08/07/2018 04:46:32 PM Eastern Daylight Time	08/07/2018 05:10:22 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Standard Enhanced Rx (HMO)	01	01		1			H9001	015	0	2019	Worcester and Franklin counties		2	11215	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	019	0	1	01	01	H9001_019_0	4	1	2	1	2	08/07/2018	2019.01	08/07/2018 05:15:54 PM Eastern Daylight Time	08/07/2018 04:46:48 PM Eastern Daylight Time	08/07/2018 05:10:22 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/navicare	NaviCare (HMO SNP)	01	01		1			H9001	019	0	2019	Massachusetts except Dukes and Nantucket counties		2	90955	2			1	3		1		1	fallonhealth.org/navicare-pharmacy	fallonhealth.org/navicare-formulary	fallonhealth.org/FindPhysician	(877)700-6996		(877)700-6996		(877)255-7108		(877)255-7108		(877)700-6996		(877)700-6996		(877)255-7108		(877)255-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H9001	029	4	1	01	01	H9001_029_4	2	1			2	06/01/2018	2019.01	06/01/2018 10:44:52 AM Eastern Daylight Time	06/04/2018 02:33:42 PM Eastern Daylight Time				06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	4	2019	Massachusetts except Dukes and Nantucket counties	Barnstable county	2	12	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	5	1	01	01	H9001_029_5	2	1			2	06/01/2018	2019.01	06/01/2018 10:44:17 AM Eastern Daylight Time	06/04/2018 02:33:43 PM Eastern Daylight Time				06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	5	2019	Massachusetts except Dukes and Nantucket counties	Hampden and Hampshire counties	2	523	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	6	1	01	01	H9001_029_6	2	1			2	05/31/2018	2019.01	05/31/2018 04:33:07 PM Eastern Daylight Time	06/04/2018 02:33:43 PM Eastern Daylight Time				06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	6	2019	Massachusetts except Dukes and Nantucket counties	Worcester and Franklin counties	2	3116	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	7	1	01	01	H9001_029_7	2	1			2	06/01/2018	2019.01	06/01/2018 10:45:29 AM Eastern Daylight Time	06/04/2018 02:33:44 PM Eastern Daylight Time				06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	7	2019	Massachusetts except Dukes and Nantucket counties	Berkshire county	2	12	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	8	1	01	01	H9001_029_8	2	1			2	06/01/2018	2019.01	06/01/2018 10:47:13 AM Eastern Daylight Time	06/04/2018 02:33:44 PM Eastern Daylight Time				06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	8	2019	Massachusetts except Dukes and Nantucket counties	Essex, Suffolk and Plymouth counties	2	196	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	9	1	01	01	H9001_029_9	2	1			2	06/01/2018	2019.01	06/01/2018 10:48:10 AM Eastern Daylight Time	06/04/2018 02:33:44 PM Eastern Daylight Time				06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	9	2019	Massachusetts except Dukes and Nantucket counties	Bristol, Middlesex and Norfolk counties	2	588	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	030	4	1	01	01	H9001_030_4	5	1			2	08/09/2018	2019.01	08/09/2018 04:23:25 PM Eastern Daylight Time	08/10/2018 02:17:25 PM Eastern Daylight Time	08/07/2018 05:10:22 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO)	01	01		1			H9001	030	4	2019	Massachusetts except DUK, FRA, NAN, WOR counties	Barnstable county	2	12	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	5	1	01	01	H9001_030_5	5	1			2	08/09/2018	2019.01	08/09/2018 04:22:15 PM Eastern Daylight Time	08/07/2018 04:47:10 PM Eastern Daylight Time	08/07/2018 05:10:22 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO)	01	01		1			H9001	030	5	2019	Massachusetts except DUK, FRA, NAN, WOR counties	Hampden and Hampshire counties	2	12	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	7	1	01	01	H9001_030_7	5	1			2	08/09/2018	2019.01	08/09/2018 04:23:58 PM Eastern Daylight Time	08/10/2018 02:17:26 PM Eastern Daylight Time	08/07/2018 05:10:22 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO)	01	01		1			H9001	030	7	2019	Massachusetts except DUK, FRA, NAN, WOR counties	Berkshire county	2	12	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	8	1	01	01	H9001_030_8	5	1			2	08/09/2018	2019.01	08/09/2018 04:22:33 PM Eastern Daylight Time	08/07/2018 04:47:32 PM Eastern Daylight Time	08/07/2018 05:10:22 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO)	01	01		1			H9001	030	8	2019	Massachusetts except DUK, FRA, NAN, WOR counties	Essex, Suffolk and Plymouth counties	2	12	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	9	1	01	01	H9001_030_9	5	1			2	08/09/2018	2019.01	08/09/2018 04:22:43 PM Eastern Daylight Time	08/07/2018 04:47:40 PM Eastern Daylight Time	08/07/2018 05:10:22 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO)	01	01		1			H9001	030	9	2019	Massachusetts except DUK, FRA, NAN, WOR counties	Bristol, Middlesex and Norfolk counties	2	5681	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	4	1	01	01	H9001_031_4	4	1			2	08/07/2018	2019.01	08/07/2018 05:17:05 PM Eastern Daylight Time	08/07/2018 04:47:52 PM Eastern Daylight Time	08/07/2018 05:10:23 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO)	01	01		1			H9001	031	4	2019	Massachusetts except DUK, HMD, HMP, NAN counties	Barnstable county	2	338	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	6	1	01	01	H9001_031_6	4	1			2	08/07/2018	2019.01	08/07/2018 05:17:12 PM Eastern Daylight Time	08/07/2018 04:47:58 PM Eastern Daylight Time	08/07/2018 05:10:23 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO)	01	01		1			H9001	031	6	2019	Massachusetts except DUK, HMD, HMP, NAN counties	Worcester and Franklin counties	2	8547	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	7	1	01	01	H9001_031_7	6	1			2	08/07/2018	2019.01	08/07/2018 07:03:11 PM Eastern Daylight Time	08/07/2018 04:48:06 PM Eastern Daylight Time	08/07/2018 05:49:08 PM Eastern Daylight Time			08/07/2018 07:05:31 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO)	01	01		1			H9001	031	7	2019	Massachusetts except DUK, HMD, HMP, NAN counties	Berkshire county	2	63	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	8	1	01	01	H9001_031_8	4	1			2	08/07/2018	2019.01	08/07/2018 05:17:24 PM Eastern Daylight Time	08/07/2018 04:48:12 PM Eastern Daylight Time	08/07/2018 05:10:23 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO)	01	01		1			H9001	031	8	2019	Massachusetts except DUK, HMD, HMP, NAN counties	Essex, Suffolk and Plymouth counties	2	2662	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	9	1	01	01	H9001_031_9	4	1			2	08/07/2018	2019.01	08/07/2018 05:17:31 PM Eastern Daylight Time	08/07/2018 04:48:20 PM Eastern Daylight Time	08/07/2018 05:10:23 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO)	01	01		1			H9001	031	9	2019	Massachusetts except DUK, HMD, HMP, NAN counties	Bristol, Middlesex and Norfolk counties	2	7401	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	4	1	01	01	H9001_032_4	5	1			2	08/09/2018	2019.01	08/09/2018 04:32:14 PM Eastern Daylight Time	08/07/2018 04:43:04 PM Eastern Daylight Time	08/07/2018 05:10:23 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	4	2019	Massachusetts except Dukes and Nantucket counties	Barnstable county	2	3680	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	5	1	01	01	H9001_032_5	5	1			2	08/09/2018	2019.01	08/09/2018 04:32:08 PM Eastern Daylight Time	08/07/2018 04:43:30 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	5	2019	Massachusetts except Dukes and Nantucket counties	Hampden and Hampshire counties	2	1430	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	6	1	01	01	H9001_032_6	5	1			2	08/09/2018	2019.01	08/09/2018 04:32:00 PM Eastern Daylight Time	08/07/2018 04:43:54 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	6	2019	Massachusetts except Dukes and Nantucket counties	Worcester and Franklin counties	2	7661	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	7	1	01	01	H9001_032_7	5	1			2	08/09/2018	2019.01	08/09/2018 04:31:53 PM Eastern Daylight Time	08/07/2018 04:44:12 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	7	2019	Massachusetts except Dukes and Nantucket counties	Berkshire county	2	388	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	8	1	01	01	H9001_032_8	5	1			2	08/09/2018	2019.01	08/09/2018 04:31:44 PM Eastern Daylight Time	08/07/2018 04:44:28 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	8	2019	Massachusetts except Dukes and Nantucket counties	Essex, Suffolk and Plymouth counties	2	1907	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	9	1	01	01	H9001_032_9	5	1			2	08/09/2018	2019.01	08/09/2018 04:31:36 PM Eastern Daylight Time	08/07/2018 04:44:46 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/10/2018 02:28:59 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	9	2019	Massachusetts except Dukes and Nantucket counties	Bristol, Middlesex and Norfolk counties	2	4248	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	033	0	1	02	01	H9001_033_0	4	1			2	08/07/2018	2019.01	08/07/2018 05:18:32 PM Eastern Daylight Time	08/07/2018 04:45:08 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO-POS)	01	02		1			H9001	033	0	2019	Hampden and Hampshire counties		2	6950	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	5	1	01	01	H9001_034_5	4	1			2	08/07/2018	2019.01	08/07/2018 05:18:39 PM Eastern Daylight Time	08/07/2018 04:45:20 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Flex Enhanced Rx (HMO)	01	01		1			H9001	034	5	2019	Massachusetts except BAR, BER, DUK, NAN counties	Hampden and Hampshire counties	2	3068	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	6	1	01	01	H9001_034_6	4	1			2	08/07/2018	2019.01	08/07/2018 05:18:45 PM Eastern Daylight Time	08/07/2018 04:45:34 PM Eastern Daylight Time	08/07/2018 05:10:24 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Flex Enhanced Rx (HMO)	01	01		1			H9001	034	6	2019	Massachusetts except BAR, BER, DUK, NAN counties	Worcester and Franklin counties	2	9764	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	8	1	01	01	H9001_034_8	4	1			2	08/07/2018	2019.01	08/07/2018 05:18:51 PM Eastern Daylight Time	08/07/2018 04:45:46 PM Eastern Daylight Time	08/07/2018 05:10:25 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Flex Enhanced Rx (HMO)	01	01		1			H9001	034	8	2019	Massachusetts except BAR, BER, DUK, NAN counties	Essex, Suffolk and Plymouth counties	2	2891	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	9	1	01	01	H9001_034_9	4	1			2	08/07/2018	2019.01	08/07/2018 05:18:57 PM Eastern Daylight Time	08/07/2018 04:46:06 PM Eastern Daylight Time	08/07/2018 05:10:25 PM Eastern Daylight Time			08/07/2018 05:24:56 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	Fallon Senior Plan Flex Enhanced Rx (HMO)	01	01		1			H9001	034	9	2019	Massachusetts except BAR, BER, DUK, NAN counties	Bristol, Middlesex and Norfolk counties	2	5035	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	803	0	1	01	01	H9001_803_0	2	1				05/25/2018	2019.01	05/25/2018 10:09:02 AM Eastern Daylight Time					06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	MA-PD HMO (HMO)	01	01		1			H9001	803	0	2019	Full Service Area - Employer Groups		1	10046	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8b1;8b2;8b3;9a1;9b;18a;	1					1				
H9001	804	0	1	02	01	H9001_804_0	2	1				06/01/2018	2019.01	06/01/2018 10:29:22 AM Eastern Daylight Time					06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	MA-PD HMO POS (HMO-POS)	01	02		1			H9001	804	0	2019	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9001	805	0	1	01	01	H9001_805_0	2	1				05/25/2018	2019.01	05/25/2018 10:12:46 AM Eastern Daylight Time					06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	MA only (HMO)	01	01		1			H9001	805	0	2019	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8b1;8b2;8b3;9a1;9b;18a;	1					1				
H9001	806	0	1	01	01	H9001_806_0	2	1				05/25/2018	2019.01	05/25/2018 10:14:30 AM Eastern Daylight Time					06/04/2018 02:41:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/seniorplan	MA only Non-calendar (HMO)	01	01		1			H9001	806	0	2019	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7h;7i;8b1;8b2;8b3;9a1;9b;18a;	1					1				
H9003	001	0	1	01	01	H9003_001_0	6	1				08/02/2018	2019.01	08/02/2018 10:30:54 AM Pacific Daylight Time	08/02/2018 05:46:30 PM Pacific Daylight Time	08/02/2018 05:52:04 PM Pacific Daylight Time			08/03/2018 01:34:02 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H9003	001	0	2019	Portland-Vancouver Metro, Salem OR, Longview WA		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9003	006	0	1	01	01	H9003_006_0	6	1				08/02/2018	2019.01	08/02/2018 10:31:46 AM Pacific Daylight Time	08/02/2018 05:48:00 PM Pacific Daylight Time	08/02/2018 05:53:27 PM Pacific Daylight Time			08/03/2018 01:34:02 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H9003	006	0	2019	Portland-Vancouver Metro, Salem OR, Longview WA		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9003	801	0	1	01	01	H9003_801_0	4	1				06/01/2018	2019.01	06/01/2018 02:40:04 PM Pacific Daylight Time					06/04/2018 12:23:11 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only with Part D (HMO)	01	01		1			H9003	801	0	2019	Portland-Vancouver Metro, Salem OR, Longview WA		1	250636	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9003	802	0	1	01	01	H9003_802_0	4	1				05/31/2018	2019.01	05/31/2018 11:31:32 AM Pacific Daylight Time					06/04/2018 12:23:11 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only without Part D (HMO)	01	01		1			H9003	802	0	2019	Portland-Vancouver Metro, Salem OR, Longview WA		1	44622	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9003	805	0	1	01	01	H9003_805_0	4	1				05/31/2018	2019.01	05/31/2018 10:11:12 AM Pacific Daylight Time					06/04/2018 12:23:11 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H9003	805	0	2019	Portland-Vancouver Metro, Salem OR, Longview WA		1	49960	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9047	001	0	1	01	01	H9047_001_0	6	1				08/02/2018	2019.01	08/02/2018 02:20:53 PM Pacific Daylight Time	08/06/2018 07:43:38 AM Pacific Daylight Time	08/06/2018 07:35:52 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Extra + RX (HMO)	01	01		1			H9047	001	0	2019	Portland Metro, Willamette Valley, Clark County		2	111738	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	013	0	2	01	01	H9047_013_0	7	1				08/02/2018	2019.01	08/02/2018 02:21:36 PM Pacific Daylight Time	08/06/2018 07:44:35 AM Pacific Daylight Time	08/06/2018 07:36:31 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Extra Part B Only + RX (HMO)	01	01		2	1		H9047	013	0	2019	Portland Metro and Willamette Valley		2	12	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	024	0	1	02	01	H9047_024_0	6	1				08/02/2018	2019.01	08/02/2018 02:23:09 PM Pacific Daylight Time	08/06/2018 07:45:30 AM Pacific Daylight Time	08/06/2018 07:37:10 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Choice + RX (HMO-POS)	01	02		1			H9047	024	0	2019	Portland Metro, Willamette Valley, Clark County		2	277239	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	033	0	1	01	01	H9047_033_0	5	1				06/28/2018	2019.01	06/28/2018 07:57:50 AM Pacific Daylight Time	06/26/2018 06:54:46 PM Pacific Daylight Time				07/10/2018 11:56:18 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Focus Medical (HMO)	01	01		1			H9047	033	0	2019	Portland Metro, Willamette Valley, Clark County		2	9174	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9047	035	0	1	02	01	H9047_035_0	5	1				06/28/2018	2019.01	06/28/2018 08:02:57 AM Pacific Daylight Time	06/26/2018 06:55:21 PM Pacific Daylight Time				07/10/2018 11:56:18 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Select Medical (HMO-POS)	01	02		1			H9047	035	0	2019	Portland Metro, Willamette Valley, Clark County		2	16080	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9047	037	0	1	01	01	H9047_037_0	6	1				08/02/2018	2019.01	08/02/2018 02:27:54 PM Pacific Daylight Time	08/06/2018 07:46:26 AM Pacific Daylight Time	08/06/2018 07:37:51 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Prime + RX (HMO)	01	01		1			H9047	037	0	2019	Portland Metro		2	80235	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	038	0	1	02	01	H9047_038_0	6	1				08/02/2018	2019.01	08/02/2018 02:24:25 PM Pacific Daylight Time	08/06/2018 07:47:22 AM Pacific Daylight Time	08/06/2018 07:38:31 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Latitude + RX (HMO-POS)	01	02		1			H9047	038	0	2019	Central OR, Hood River		2	6000	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	039	0	1	02	01	H9047_039_0	6	1				08/02/2018	2019.01	08/02/2018 02:25:29 PM Pacific Daylight Time	08/06/2018 07:48:22 AM Pacific Daylight Time	08/06/2018 07:39:10 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Compass + RX (HMO-POS)	01	02		1			H9047	039	0	2019	Central OR, Hood River		2	8340	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	043	0	1	01	01	H9047_043_0	7	1	2	1		08/02/2018	2019.01	08/02/2018 02:33:12 PM Pacific Daylight Time	08/06/2018 07:49:19 AM Pacific Daylight Time	08/06/2018 07:39:51 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Dual Plus (HMO SNP)	01	01		1			H9047	043	0	2019	Portland Metro		2	10986	2			1	3		2		2	providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	045	0	1	01	01	H9047_045_0	6	1				06/28/2018	2019.01	06/28/2018 08:12:15 AM Pacific Daylight Time	08/06/2018 07:50:16 AM Pacific Daylight Time	08/06/2018 07:40:33 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Enrich + RX (HMO)	01	01		1			H9047	045	0	2019	Linn and Benton Counties		2	1800	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	047	0	1	02	01	H9047_047_0	7	1				08/03/2018	2019.01	08/03/2018 10:38:06 AM Pacific Daylight Time	08/06/2018 07:51:11 AM Pacific Daylight Time	08/06/2018 07:41:17 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Summit + RX (HMO-POS)	01	02		1			H9047	047	0	2019	King and Snohomish Counties		2	3456	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	049	0	1	01	01	H9047_049_0	7	1				08/02/2018	2019.01	08/02/2018 02:29:19 PM Pacific Daylight Time	08/06/2018 07:52:07 AM Pacific Daylight Time	08/06/2018 07:41:57 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Harbor + RX (HMO)	01	01		1			H9047	049	0	2019	King and Snohomish Counties		2	10944	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	054	0	1	01	01	H9047_054_0	7	1				08/02/2018	2019.01	08/02/2018 02:30:07 PM Pacific Daylight Time	08/06/2018 07:53:02 AM Pacific Daylight Time	08/06/2018 07:42:38 AM Pacific Daylight Time			08/06/2018 08:40:49 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Timber + RX (HMO)	01	01		1			H9047	054	0	2019	Lane county		2	42000	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	804	0	1	01	01	H9047_804_0	5	1				06/28/2018	2019.01	06/28/2018 07:45:38 AM Pacific Daylight Time					07/16/2018 12:34:46 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Align Group Plan + RX (HMO)	01	01		1			H9047	804	0	2019	Portland, Willamette Valley,Central OR, Washington		1	17352	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	805	0	1	02	01	H9047_805_0	4	1				05/30/2018	2019.01	05/30/2018 10:41:12 AM Pacific Daylight Time					05/31/2018 02:47:52 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Flex Group Plan + RX (HMO-POS)	01	02		1			H9047	805	0	2019	Portland, Willamette Valley,Central OR, Washington		1	492	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7g;16b;17a;18a;	1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;14a;15;16b;	2		1				
H9047	808	0	1	01	01	H9047_808_0	4	1				05/24/2018	2019.01	05/24/2018 02:09:11 PM Pacific Daylight Time					05/31/2018 02:47:52 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Align Group Plan + RX (HMO)	01	01		1			H9047	808	0	2019	Portland Metro, Willamette Valley,Central OR,Clark		1	111684	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	809	0	1	02	01	H9047_809_0	4	1				05/29/2018	2019.01	05/29/2018 08:34:13 AM Pacific Daylight Time					05/31/2018 02:47:52 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Flex Group Plan + RX (HMO-POS)	01	02		1			H9047	809	0	2019	Portland Metro, Willamette Valley,Central OR,Clark		1	45774	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	001	0	1	01	01	H9066_001_0	9	1	2	1		08/04/2018	2019.01	08/04/2018 07:38:07 AM Eastern Daylight Time	08/04/2018 07:35:05 AM Eastern Daylight Time	08/06/2018 09:05:14 AM Eastern Daylight Time			08/07/2018 07:07:57 AM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.vnahomecareoptions.org	Nascentia Health Plus (HMO SNP)	01	01		1			H9066	001	0	2019	Upstate New York		2	4497	2			1	3		1		1	www.envisionrx.com	www.envisionrx.com	www.vnahomecareoptions.org	(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	002	0	1	01	01	H9066_002_0	11	1		1		08/04/2018	2019.01	08/04/2018 07:38:23 AM Eastern Daylight Time	08/04/2018 07:35:09 AM Eastern Daylight Time	08/06/2018 09:05:36 AM Eastern Daylight Time			08/07/2018 07:07:57 AM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.vnahomecareoptions.org	Nascentia Health Institutional (HMO SNP)	01	01		1			H9066	002	0	2019	Upstate New York		2	1604	2			1	1	1				www.envisionrx.com	www.envisionrx.com	www.vnahomecareoptions.org	(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	003	0	1	01	01	H9066_003_0	11	1	2	1		08/06/2018	2019.01	08/06/2018 04:02:06 PM Eastern Daylight Time	08/04/2018 07:35:13 AM Eastern Daylight Time	08/06/2018 09:06:10 AM Eastern Daylight Time			08/07/2018 07:07:57 AM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.vnahomecareoptions.org	Nascentia Health Dual (HMO SNP)	01	01		1			H9066	003	0	2019	Upstate New York		2	21100	2			1	3		2		1	www.envisionrx.com	www.envisionrx.com	www.vnahomecareoptions.org	(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9068	001	0	1	20	08	H9068_001_0	1	1				05/22/2018	2019.01	05/22/2018 03:31:23 PM Eastern Daylight Time		05/21/2018 04:35:20 PM Eastern Daylight Time			05/22/2018 03:33:20 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE (PACE)	08	20		1			H9068	001	0	2019	Lanc,Lebanon,Lyco,Union,19320Chester,17777North'd		2		2			2						www.albrightcare.org	www.albrightcare.org										(888)791-0094		(570)522-3880		(888)791-0094		(570)522-3880										(711)-		(711)-		(711)-		(711)-																
H9068	002	0	1	20	08	H9068_002_0	1	1				05/22/2018	2019.01	05/22/2018 03:31:53 PM Eastern Daylight Time		05/21/2018 04:35:49 PM Eastern Daylight Time			05/22/2018 03:33:20 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE Medicare Only (PACE)	08	20		1			H9068	002	0	2019	Lanc,Lebanon,Lyco,Union,19320Chester,17777North'd		2		2			2						www.albrightcare.org	www.albrightcare.org										(888)791-0094		(570)522-3880		(888)791-0094		(570)522-3880										(711)-		(711)-		(711)-		(711)-																
H9070	001	0	1	04	01	H9070_001_0	3	1				07/02/2018	2019.01	07/02/2018 01:13:22 PM Eastern Daylight Time	06/01/2018 03:13:26 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:21:17 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-001 (PPO)	01	04		1			H9070	001	0	2019	Select counties in Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	002	0	1	04	01	H9070_002_0	4	1				07/12/2018	2019.01	07/12/2018 09:06:11 AM Eastern Daylight Time	06/01/2018 02:49:03 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:21:17 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H9070-002 (PPO)	01	04		1			H9070	002	0	2019	Select counties in Oklahoma		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9082	007	0	1	01	01	H9082_007_0	4	1	2	1		07/12/2018	2019.01	07/12/2018 01:44:29 PM Pacific Daylight Time	08/04/2018 10:31:20 AM Pacific Daylight Time	08/04/2018 11:23:02 AM Pacific Daylight Time			08/06/2018 04:12:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Molina Healthcare of New Mexico, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H9082	007	0	2019	Albuquerque, Santa Fe		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)440-0127		(866)440-0127		(866)403-8293		(866)403-8293		(866)440-0127		(866)440-0127		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	001	0	1	01	01	H9096_001_0	7	1				07/16/2018	2019.01	07/16/2018 09:44:32 AM Central Daylight Time	08/07/2018 02:12:54 PM Central Daylight Time	08/07/2018 02:12:54 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Assurance (HMO)	01	01		1			H9096	001	0	2019	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	002	0	1	01	01	H9096_002_0	7	1				07/16/2018	2019.01	07/16/2018 09:44:51 AM Central Daylight Time	08/07/2018 02:12:55 PM Central Daylight Time	08/07/2018 02:12:55 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Balance (HMO)	01	01		1			H9096	002	0	2019	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	003	0	1	02	01	H9096_003_0	7	1				07/16/2018	2019.01	07/16/2018 09:45:08 AM Central Daylight Time	08/07/2018 02:12:55 PM Central Daylight Time	08/07/2018 02:12:55 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Confidence (HMO-POS)	01	02		1			H9096	003	0	2019	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	004	0	1	01	01	H9096_004_0	7	1				07/16/2018	2019.01	07/16/2018 09:45:24 AM Central Daylight Time	08/07/2018 02:12:55 PM Central Daylight Time	08/07/2018 02:12:55 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Essential (HMO)	01	01		1			H9096	004	0	2019	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	005	0	1	01	01	H9096_005_0	7	1				07/16/2018	2019.01	07/16/2018 09:45:42 AM Central Daylight Time	08/07/2018 02:12:56 PM Central Daylight Time	08/07/2018 02:12:56 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Complete (HMO)	01	01		1			H9096	005	0	2019	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	006	0	1	01	01	H9096_006_0	7	1				07/16/2018	2019.01	07/16/2018 09:46:12 AM Central Daylight Time	08/07/2018 02:12:56 PM Central Daylight Time	08/07/2018 02:12:56 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage Essential (HMO)	01	01		1			H9096	006	0	2019	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	007	0	1	01	01	H9096_007_0	7	1				07/16/2018	2019.01	07/16/2018 09:46:29 AM Central Daylight Time	08/07/2018 02:12:56 PM Central Daylight Time	08/07/2018 02:12:57 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage Assurance (HMO)	01	01		1			H9096	007	0	2019	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	008	0	1	01	01	H9096_008_0	7	1				07/16/2018	2019.01	07/16/2018 09:46:44 AM Central Daylight Time	08/07/2018 02:12:57 PM Central Daylight Time	08/07/2018 02:12:57 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage Balance (HMO)	01	01		1			H9096	008	0	2019	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	009	0	1	01	01	H9096_009_0	7	1				07/16/2018	2019.01	07/16/2018 09:47:02 AM Central Daylight Time	08/07/2018 02:12:57 PM Central Daylight Time	08/07/2018 02:12:57 PM Central Daylight Time			08/07/2018 04:51:27 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage Complete (HMO)	01	01		1			H9096	009	0	2019	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	801	0	1	01	01	H9096_801_0	5	1				06/01/2018	2019.01	06/01/2018 02:08:18 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage - EGWP MAPD CY (HMO)	01	01		1			H9096	801	0	2019	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	802	0	1	01	01	H9096_802_0	5	1				05/30/2018	2019.01	05/30/2018 05:07:46 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage - EGWP MAPD Non CY (HMO)	01	01		1			H9096	802	0	2019	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	803	0	1	01	01	H9096_803_0	5	1				05/30/2018	2019.01	05/30/2018 05:07:56 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage - EGWP MA only (HMO)	01	01		1			H9096	803	0	2019	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	804	0	1	02	01	H9096_804_0	5	1				05/30/2018	2019.01	05/30/2018 05:08:07 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage EGWP CY HMOPOS (HMO-POS)	01	02		1			H9096	804	0	2019	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	805	0	1	02	01	H9096_805_0	5	1				05/30/2018	2019.01	05/30/2018 05:08:16 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage EGWP Non CY HMOPOS (HMO-POS)	01	02		1			H9096	805	0	2019	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	806	0	1	02	01	H9096_806_0	5	1				05/30/2018	2019.01	05/30/2018 05:08:25 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage EGWP MA Only HMOPOS (HMO-POS)	01	02		1			H9096	806	0	2019	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	807	0	1	01	01	H9096_807_0	5	1				05/30/2018	2019.01	05/30/2018 05:08:35 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage - EGWP MAPD CY (HMO)	01	01		1			H9096	807	0	2019	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	808	0	1	01	01	H9096_808_0	5	1				05/30/2018	2019.01	05/30/2018 05:08:43 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage - EGWP MAPD Non CY (HMO)	01	01		1			H9096	808	0	2019	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	809	0	1	01	01	H9096_809_0	5	1				05/30/2018	2019.01	05/30/2018 05:08:52 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage - EGWP MA Only (HMO)	01	01		1			H9096	809	0	2019	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	810	0	1	02	01	H9096_810_0	5	1				05/30/2018	2019.01	05/30/2018 05:09:00 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage EGWP CY HMOPOS (HMO-POS)	01	02		1			H9096	810	0	2019	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	811	0	1	02	01	H9096_811_0	5	1				05/30/2018	2019.01	05/30/2018 05:09:09 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage EGWP Non CY HMOPOS (HMO-POS)	01	02		1			H9096	811	0	2019	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	812	0	1	02	01	H9096_812_0	4	1				05/30/2018	2019.01	05/30/2018 05:09:18 PM Central Daylight Time					06/04/2018 04:27:11 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage or Prevea360 Medicare Advantage	www.deancare.com/medicare	Prevea360 Medicare Advantage EGWP MA Only HMOPOS (HMO-POS)	01	02		1			H9096	812	0	2019	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.deancare.com/find-a-doc/	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9104	006	0	1	01	01	H9104_006_0	5	1		1		07/18/2018	2019.01	07/18/2018 10:37:32 AM Pacific Daylight Time	08/01/2018 03:39:12 PM Pacific Daylight Time	08/01/2018 09:52:51 AM Pacific Daylight Time			08/06/2018 04:25:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Healthy at Home (HMO SNP)	01	01		1			H9104	006	0	2019	Los Angeles, Orange, and Inland Empire Areas		2		2			1	1	2				www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9153	001	0	1	01	01	H9153_001_0	4	1		1		08/03/2018	2019.01	08/03/2018 09:41:30 AM Eastern Daylight Time	08/07/2018 02:52:17 PM Eastern Daylight Time	08/07/2018 02:52:17 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	WEST VIRGINIA SENIOR ADVANTAGE, INC.	West Virginia Senior Advantage (HMO SNP)	www.wvsenioradvantage.com	WV Senior Advantage (HMO SNP)	01	01		1			H9153	001	0	2019	BER,GRB,HSN,KA,MNL,MGL,MRO,MOR,PL,PR,RAL&WOD		2	6242	2			1	1	1				www.wvsenioradvantage.com	www.wvsenioradvantage.com	www.wvsenioradvantage.com	(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9185	001	0	1	20	08	H9185_001_0	1	1				05/23/2018	2019.01	05/23/2018 09:33:06 AM Eastern Daylight Time		05/21/2018 11:04:22 AM Eastern Daylight Time			05/23/2018 09:35:57 AM Eastern Daylight Time	A&D CHARITABLE FOUNDATION, INC.	Great Lakes PACE	http://www.greatlakespace.org	Great Lakes PACE - Dual Eligible (PACE)	08	20		1			H9185	001	0	2019	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2						www.a-dhomecare.com	www.a-dhomecare.com										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7619																
H9185	002	0	1	20	08	H9185_002_0	1	1				05/23/2018	2019.01	05/23/2018 09:33:22 AM Eastern Daylight Time		05/21/2018 11:04:02 AM Eastern Daylight Time			05/23/2018 09:35:57 AM Eastern Daylight Time	A&D CHARITABLE FOUNDATION, INC.	Great Lakes PACE	http://www.greatlakespace.org	Great Lakes PACE (PACE)	08	20		1			H9185	002	0	2019	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2						www.a-dhomecare.com	www.a-dhomecare.com										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610																
H9190	001	0	1	01	01	H9190_001_0	13	1	2	1		08/07/2018	2019.01	08/07/2018 12:40:13 PM Eastern Daylight Time	08/07/2018 02:03:35 PM Eastern Daylight Time	08/07/2018 02:03:42 PM Eastern Daylight Time			08/07/2018 02:20:48 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	001	0	2019	Ohio Counties		2	12782	2			1	3		1		1	www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	002	0	1	01	01	H9190_002_0	12	1	2	1		08/07/2018	2019.01	08/07/2018 12:41:36 PM Eastern Daylight Time	08/07/2018 02:03:57 PM Eastern Daylight Time	08/07/2018 02:04:07 PM Eastern Daylight Time			08/07/2018 02:20:48 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	002	0	2019	Ohio Counties		2	2631	2			1	3		2		2	www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	007	0	1	01	01	H9190_007_0	16	1	2	1		08/07/2018	2019.01	08/07/2018 01:26:56 PM Eastern Daylight Time	08/07/2018 02:04:25 PM Eastern Daylight Time	08/07/2018 02:04:32 PM Eastern Daylight Time			08/07/2018 02:20:48 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	007	0	2019	North Carolina Counties		2	15092	2			1	3		1		1	www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	008	0	1	01	01	H9190_008_0	13	1	2	1		08/07/2018	2019.01	08/07/2018 01:14:32 PM Eastern Daylight Time	08/07/2018 02:02:03 PM Eastern Daylight Time	08/07/2018 02:02:17 PM Eastern Daylight Time			08/07/2018 02:20:48 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	008	0	2019	North Carolina Counties		2	1776	2			1	3		2		2	www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	002	0	1	01	01	H9207_002_0	12	1				07/25/2018	2019.01	07/25/2018 12:14:27 PM Eastern Daylight Time	08/02/2018 03:56:02 PM Eastern Daylight Time	08/02/2018 03:52:48 PM Eastern Daylight Time			08/03/2018 04:02:36 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO)	01	01		1			H9207	002	0	2019	Philadelphia County		2	57597	2			2						HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	004	0	1	01	01	H9207_004_0	9	1	2	1		08/22/2018	2019.01	08/22/2018 11:10:47 AM Eastern Daylight Time	08/02/2018 03:58:28 PM Eastern Daylight Time	08/02/2018 03:53:46 PM Eastern Daylight Time			08/22/2018 12:29:33 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Special (HMO SNP)	01	01		1			H9207	004	0	2019	Bucks, Chester, Del, Lan, Leh, Nrtha, Phila		2	192240	2			1	3		2		2	HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	005	0	1	01	01	H9207_005_0	9	1				07/25/2018	2019.01	07/25/2018 12:30:02 PM Eastern Daylight Time	08/02/2018 03:59:28 PM Eastern Daylight Time	08/02/2018 03:54:34 PM Eastern Daylight Time			08/03/2018 04:02:36 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO)	01	01		1			H9207	005	0	2019	Bucks, Chester, and Delaware Counties		2	5175	2			2						HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	010	0	1	01	01	H9207_010_0	10	1				07/25/2018	2019.01	07/25/2018 12:36:26 PM Eastern Daylight Time	08/02/2018 04:00:48 PM Eastern Daylight Time	08/02/2018 03:51:56 PM Eastern Daylight Time			08/03/2018 04:02:36 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO)	01	01		1			H9207	010	0	2019	Lancaster, Lehigh, Northampton Counties		2	192	2			2						HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9266	001	0	1	20	08	H9266_001_0	1	1				05/23/2018	2019.01	05/23/2018 01:09:38 PM Eastern Daylight Time		05/22/2018 03:52:49 PM Eastern Daylight Time			05/23/2018 01:15:33 PM Eastern Daylight Time	PIEDMONT HEALTH SERVICES, INC.	Piedmont Health SeniorCare	http://www.piedmonthealthseniorcare.org/	Piedmont Health SeniorCare - Dual (PACE)	08	20		1			H9266	001	0	2019	Alamance, Caswell, Lee, Chatham, & Orange counties		2		2			2						no answer	no answer										(877)714-2100		(919)545-7341		(877)714-2100		(336)532-0000										(800)735-2962		(800)735-2962		(877)714-2100		(336)532-0000																
H9266	003	0	1	20	08	H9266_003_0	1	1				05/23/2018	2019.01	05/23/2018 01:11:21 PM Eastern Daylight Time		05/22/2018 03:52:42 PM Eastern Daylight Time			05/23/2018 01:15:33 PM Eastern Daylight Time	PIEDMONT HEALTH SERVICES, INC.	Piedmont Health SeniorCare	http://www.piedmonthealthseniorcare.org/	Piedmont Health SeniorCare - Medicare-only (PACE)	08	20		1			H9266	003	0	2019	Alamance, Caswell, Orange, Lee, & Chatham counties		2		2			2						no answer	no answer										(877)714-2100		(919)545-7341		(877)714-2100		(336)532-0000										(800)735-2962		(800)735-2962		(877)714-2100		(336)532-0000																
H9276	002	0	1	01	01	H9276_002_0	5	1				08/02/2018	2019.01	08/02/2018 08:51:19 PM Eastern Daylight Time	08/03/2018 07:23:35 PM Eastern Daylight Time	08/03/2018 07:52:17 PM Eastern Daylight Time			08/03/2018 09:25:56 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare Premier (HMO)	01	01		1			H9276	002	0	2019	Duval County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	004	0	1	01	01	H9276_004_0	5	1				08/01/2018	2019.01	08/01/2018 03:21:14 PM Eastern Daylight Time	08/03/2018 07:23:35 PM Eastern Daylight Time	08/03/2018 07:52:17 PM Eastern Daylight Time			08/03/2018 09:25:56 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	01	01		1			H9276	004	0	2019	Miami-Dade County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	006	0	1	01	01	H9276_006_0	5	1				08/01/2018	2019.01	08/01/2018 03:21:46 PM Eastern Daylight Time	08/03/2018 07:23:31 PM Eastern Daylight Time	08/03/2018 07:52:17 PM Eastern Daylight Time			08/03/2018 09:25:56 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	01	01		1			H9276	006	0	2019	Hillsborough, Pasco, Pinellas		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	010	0	1	01	01	H9276_010_0	5	1				08/03/2018	2019.01	08/03/2018 11:26:20 AM Eastern Daylight Time	08/06/2018 09:09:07 PM Eastern Daylight Time	08/06/2018 09:09:18 PM Eastern Daylight Time			08/06/2018 09:43:32 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	01	01		1			H9276	010	0	2019	Orange, Osceola, Seminole		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	012	0	1	01	01	H9276_012_0	5	1				08/02/2018	2019.01	08/02/2018 08:50:59 PM Eastern Daylight Time	08/03/2018 07:23:31 PM Eastern Daylight Time	08/03/2018 07:52:17 PM Eastern Daylight Time			08/03/2018 09:25:56 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	01	01		1			H9276	012	0	2019	Broward County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	021	0	1	01	01	H9276_021_0	5	1				08/01/2018	2019.01	08/01/2018 03:23:24 PM Eastern Daylight Time	08/03/2018 07:23:31 PM Eastern Daylight Time	08/03/2018 07:52:17 PM Eastern Daylight Time			08/03/2018 09:25:56 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	01	01		1			H9276	021	0	2019	Palm Beach County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	022	0	1	01	01	H9276_022_0	5	1				08/01/2018	2019.01	08/01/2018 03:23:52 PM Eastern Daylight Time	08/03/2018 07:23:32 PM Eastern Daylight Time	08/03/2018 07:52:17 PM Eastern Daylight Time			08/03/2018 09:25:56 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	01	01		1			H9276	022	0	2019	Polk County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	023	0	1	01	01	H9276_023_0	5	1				08/01/2018	2019.01	08/01/2018 03:24:22 PM Eastern Daylight Time	08/03/2018 07:23:32 PM Eastern Daylight Time	08/03/2018 07:52:17 PM Eastern Daylight Time			08/03/2018 09:25:56 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	01	01		1			H9276	023	0	2019	Volusia County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(844)293-2636		(844)293-2636		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9287	001	0	1	01	01	H9287_001_0	5	1				08/02/2018	2019.01	08/02/2018 09:10:07 AM US Mountain Standard Time	08/03/2018 11:14:24 AM Pacific Daylight Time	08/03/2018 06:18:12 PM Pacific Daylight Time			08/03/2018 07:13:34 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS OF ARIZONA, INC.	Allwell	allwell.healthnetadvantage.com	Allwell Medicare Premier (HMO)	01	01		1			H9287	001	0	2019	Pima County, AZ		2		2			2						allwell.healthnetadvantage.com/find-doctor	allwell.healthnetadvantage.com/prescription-drugs-formulary/formulary	allwell.healthnetadvantage.com/find-doctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9302	003	0	1	01	01	H9302_003_0	5	1				07/11/2018	2019.01	07/11/2018 02:59:27 PM Central Daylight Time	08/06/2018 05:41:22 PM Central Daylight Time	08/06/2018 05:41:27 PM Central Daylight Time			08/06/2018 05:44:41 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.SoundpathHealth.com	Soundpath Health Charter + Rx (HMO)	01	01		1			H9302	003	0	2019	Western Washington Areas		2		2			2						www.SoundpathHealth.com	www.SoundpathHealth.com	www.SoundpathHealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	18a;	18a1;
H9302	004	0	1	01	01	H9302_004_0	4	1				07/11/2018	2019.01	07/11/2018 03:00:26 PM Central Daylight Time	06/02/2018 06:06:56 PM Central Daylight Time				07/12/2018 03:26:23 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.SoundpathHealth.com	Soundpath Health Alpine (HMO)	01	01		1			H9302	004	0	2019	Western Washington Areas		2		2			2						www.SoundpathHealth.com	www.SoundpathHealth.com	www.SoundpathHealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830										(711)-		(711)-		(711)-		(711)-										2					2					2	1	11	18a;	18a1;
H9302	007	0	1	01	01	H9302_007_0	5	1				07/11/2018	2019.01	07/11/2018 03:01:17 PM Central Daylight Time	08/06/2018 05:41:33 PM Central Daylight Time	08/06/2018 05:41:38 PM Central Daylight Time			08/06/2018 05:44:41 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.SoundpathHealth.com	Soundpath Health Sound + Rx (HMO)	01	01		1			H9302	007	0	2019	Western Washington Areas		2		2			2						www.SoundpathHealth.com	www.SoundpathHealth.com	www.SoundpathHealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	18a;	18a1;
H9302	011	0	1	01	01	H9302_011_0	6	1				07/11/2018	2019.01	07/11/2018 03:02:43 PM Central Daylight Time	08/04/2018 10:31:45 AM Central Daylight Time	08/04/2018 10:31:49 AM Central Daylight Time			08/04/2018 10:38:11 AM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.SoundpathHealth.com	Soundpath Health Peak + Rx (HMO)	01	01		1			H9302	011	0	2019	Western Washington Areas		2		2			2						www.SoundpathHealth.com	www.SoundpathHealth.com	www.SoundpathHealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	18a;	18a1;
H9302	801	0	1	01	01	H9302_801_0	3	1				05/11/2018	2019.01	05/11/2018 03:58:12 PM Central Daylight Time					06/04/2018 05:17:11 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.SoundpathHealth.com	Soundpath Health + Rx (HMO)	01	01		1			H9302	801	0	2019	Western Washington Areas		1	12	2			2						www.SoundpathHealth.com	www.SoundpathHealth.com	www.SoundpathHealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9323	001	0	1	20	08	H9323_001_0	1	1				05/25/2018	2019.01	05/25/2018 11:35:46 AM Eastern Daylight Time		05/23/2018 04:31:37 PM Eastern Daylight Time			05/25/2018 11:37:37 AM Eastern Daylight Time	ACUTE CARE HEALTH SYSTEM, LLC	Beacon of LIFE	beaconhss.com	Beacon of LIFE (PACE)	08	20		1			H9323	001	0	2019	Monmouth County		2		2			2						NA	NA										(732)592-3400		(732)592-3400		(732)592-3400		(732)592-3400										(732)532-3400		(732)592-3400		(732)592-3400		(732)592-3400																
H9323	002	0	1	20	08	H9323_002_0	1	1				05/25/2018	2019.01	05/25/2018 11:35:58 AM Eastern Daylight Time		05/23/2018 04:31:39 PM Eastern Daylight Time			05/25/2018 11:37:37 AM Eastern Daylight Time	ACUTE CARE HEALTH SYSTEM, LLC	Beacon of LIFE	beaconhss.com	Beacon of LIFE (PACE)	08	20		1			H9323	002	0	2019	Monmouth County		2		2			2						NA	NA										(732)592-3400		(732)592-3400		(732)592-3400		(732)592-3400										(732)532-3400		(732)592-3400		(732)592-3400		(732)592-3400																
H9364	001	0	1	01	01	H9364_001_0	3	1				08/03/2018	2019.01	08/03/2018 12:17:45 PM Eastern Daylight Time	08/06/2018 06:01:06 PM Eastern Daylight Time	08/01/2018 02:49:24 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF MAINE, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H9364	001	0	2019	Selected Counties in ME		2	3846	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)682-0536		(866)682-0536		(866)527-0056		(866)527-0056		(866)682-0536		(866)682-0536		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9364	002	0	1	01	01	H9364_002_0	5	1	2	1		07/12/2018	2019.01	07/12/2018 04:38:26 PM Eastern Daylight Time	08/06/2018 06:01:49 PM Eastern Daylight Time	08/01/2018 02:49:45 PM Eastern Daylight Time			08/07/2018 03:05:39 PM Eastern Daylight Time	WELLCARE OF MAINE, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H9364	002	0	2019	Selected Counties in ME		2	2168	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)682-0537		(866)682-0537		(866)527-0056		(866)527-0056		(866)682-0537		(866)682-0537		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	001	0	1	01	01	H9403_001_0	8	1	2	1		08/07/2018	2019.01	08/07/2018 03:00:29 PM Eastern Daylight Time	08/03/2018 09:15:33 AM Eastern Daylight Time	08/03/2018 10:01:39 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (SC)	Eon Health	www.eonhealthplan.com	EON DELUXE (HMO SNP)	01	01		1			H9403	001	0	2019	Select South Carolina Counties		2		2			1	3		1		1	www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	003	0	1	01	01	H9403_003_0	7	1		1		07/05/2018	2019.01	07/05/2018 01:22:15 PM Eastern Daylight Time	08/03/2018 09:13:31 AM Eastern Daylight Time	08/03/2018 10:00:53 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (SC)	Eon Health	www.eonhealthplan.com	EON SILVER (HMO SNP)	01	01		1			H9403	003	0	2019	Select South Carolina Counties		2		2			1	4			00000000000000000010		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	004	0	1	01	01	H9403_004_0	8	1				07/05/2018	2019.01	07/05/2018 01:22:31 PM Eastern Daylight Time	08/03/2018 09:11:47 AM Eastern Daylight Time	08/03/2018 10:00:07 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (SC)	Eon Health	www.eonhealthplan.com	EON SELECT (HMO)	01	01		1			H9403	004	0	2019	Select South Carolina Counties		2		2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9408	001	0	1	04	01	H9408_001_0	5	1				06/02/2018	2019.01	06/02/2018 04:03:10 PM Eastern Daylight Time	08/02/2018 02:14:48 PM Eastern Daylight Time	08/02/2018 02:15:38 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Essential (PPO)	01	04		1			H9408	001	0	2019	Southcentral and Northeast Pennsylvania		2	32425	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9408	002	0	1	04	01	H9408_002_0	5	1				06/02/2018	2019.01	06/02/2018 04:26:51 PM Eastern Daylight Time	08/02/2018 02:17:24 PM Eastern Daylight Time	08/02/2018 02:25:26 PM Eastern Daylight Time			08/03/2018 05:58:36 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Enhanced (PPO)	01	04		1			H9408	002	0	2019	Southcentral and Northeast Pennsylvania		2	21635	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9408	801	0	1	04	01	H9408_801_0	1	1				06/02/2018	2019.01	06/02/2018 04:28:48 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Employer Group CY MAPD (PPO)	01	04		1			H9408	801	0	2019	National		1	3595	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	802	0	1	04	01	H9408_802_0	1	1				06/02/2018	2019.01	06/02/2018 04:29:11 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Employer Group FY MAPD (PPO)	01	04		1			H9408	802	0	2019	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	803	0	1	04	01	H9408_803_0	1	1				06/02/2018	2019.01	06/02/2018 04:29:44 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Employer Group CY MA (PPO)	01	04		1			H9408	803	0	2019	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	804	0	1	04	01	H9408_804_0	1	1				06/02/2018	2019.01	06/02/2018 04:30:01 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Employer Group FY MA (PPO)	01	04		1			H9408	804	0	2019	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)388-8268		(844)388-8268										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9412	803	0	1	04	01	H9412_803_0	2	1				04/23/2018	2019.01	04/23/2018 09:35:01 PM Eastern Daylight Time					06/03/2018 11:44:34 AM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Rx (PPO) EGWP NJ (PPO)	01	04		1			H9412	803	0	2019	Ocean & Monmouth Counties, NJ		1	600	2			2						www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	001	0	1	04	01	H9431_001_0	3	1				08/02/2018	2019.01	08/02/2018 11:08:26 AM Central Daylight Time	08/02/2018 04:29:41 PM Eastern Daylight Time	08/01/2018 12:09:12 AM Eastern Daylight Time			08/05/2018 07:30:26 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H9431	001	0	2019	Albuquerque		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	002	0	1	04	01	H9431_002_0	3	1				07/11/2018	2019.01	07/11/2018 05:04:46 PM Eastern Daylight Time	08/01/2018 03:12:32 PM Eastern Daylight Time	07/31/2018 06:38:04 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H9431	002	0	2019	Kootenai County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	003	0	1	04	01	H9431_003_0	3	1				05/31/2018	2019.01	05/31/2018 09:14:56 AM Eastern Daylight Time	08/01/2018 03:13:18 PM Eastern Daylight Time	07/31/2018 06:38:44 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H9431	003	0	2019	Ada and Canyon Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	004	0	1	04	01	H9431_004_0	3	1				05/30/2018	2019.01	05/30/2018 08:31:32 PM Pacific Daylight Time	08/01/2018 03:14:08 PM Eastern Daylight Time	07/31/2018 06:39:25 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H9431	004	0	2019	Jackson and Josephine Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	005	0	1	04	01	H9431_005_0	3	1				05/30/2018	2019.01	05/30/2018 08:31:20 PM Pacific Daylight Time	08/01/2018 03:14:52 PM Eastern Daylight Time	07/31/2018 06:40:07 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H9431	005	0	2019	Greater Portland Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	006	0	1	04	01	H9431_006_0	3	1				05/30/2018	2019.01	05/30/2018 08:31:06 PM Pacific Daylight Time	08/01/2018 03:15:43 PM Eastern Daylight Time	07/31/2018 06:40:49 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Alliance Prime Plan (PPO)	01	04		1			H9431	006	0	2019	Greater Boise Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	007	0	1	04	01	H9431_007_0	3	1				05/30/2018	2019.01	05/30/2018 08:30:46 PM Pacific Daylight Time	08/01/2018 03:16:33 PM Eastern Daylight Time	07/31/2018 06:41:33 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H9431	007	0	2019	Jackson and Josephine Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	008	0	1	04	01	H9431_008_0	3	1				05/30/2018	2019.01	05/30/2018 08:30:25 PM Pacific Daylight Time	08/01/2018 03:17:21 PM Eastern Daylight Time	07/31/2018 06:42:13 PM Eastern Daylight Time			08/05/2018 09:05:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H9431	008	0	2019	Greater Portland Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	009	0	1	04	01	H9431_009_0	3	1				08/01/2018	2019.01	08/01/2018 04:07:56 PM Eastern Daylight Time	08/03/2018 10:24:43 AM Central Daylight Time	07/31/2018 10:36:56 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H9431	009	0	2019	Rhode Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	010	0	1	04	01	H9431_010_0	3	1				07/09/2018	2019.01	07/09/2018 11:11:21 AM Central Daylight Time	08/03/2018 10:25:22 AM Central Daylight Time	07/31/2018 10:37:48 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Complete (PPO)	01	04		1			H9431	010	0	2019	Rhode Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	011	0	1	04	01	H9431_011_0	3	1				08/01/2018	2019.01	08/01/2018 04:09:04 PM Eastern Daylight Time	08/03/2018 10:26:04 AM Central Daylight Time	07/31/2018 10:38:38 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H9431	011	0	2019	New Hampshire		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	012	0	1	04	01	H9431_012_0	3	1				07/09/2018	2019.01	07/09/2018 11:11:49 AM Central Daylight Time	08/03/2018 10:26:43 AM Central Daylight Time	07/31/2018 10:39:28 PM Central Daylight Time			08/05/2018 07:55:00 AM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Complete (PPO)	01	04		1			H9431	012	0	2019	New Hampshire		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(833)570-6670		(833)570-6670		(855)335-1407		(855)335-1407		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	801	0	1	04	01	H9431_801_0	2	1				06/04/2018	2019.01	06/04/2018 11:54:29 AM Eastern Daylight Time					06/04/2018 12:10:42 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	w.aetnamedicare.com	Aetna Medicare Plan (PPO) (PPO)	01	04		1			H9431	801	0	2019	ID, OR, RI, NH, NM		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9431	802	0	1	04	01	H9431_802_0	2	1				06/04/2018	2019.01	06/04/2018 11:54:18 AM Eastern Daylight Time					06/04/2018 12:10:42 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx cy (PPO) (PPO)	01	04		1			H9431	802	0	2019	ID, OR, RI, NH, NM		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9438	001	0	1	20	08	H9438_001_0	1	1				05/23/2018	2019.01	05/23/2018 08:56:01 AM Central Daylight Time		05/23/2018 08:48:27 AM Central Daylight Time			05/23/2018 08:58:16 AM Central Daylight Time	BLUESTEM PACE, INC.	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	08	20		1			H9438	001	0	2019	Counties:  RC, HV, RN, MN, MP, SA, EW, DK, OT, LC		2		2			2						NA	NA										(844)588-7223		(620)504-5900		(844)588-7223		(620)504-5674												(620)504-5900		(844)588-7223		(620)504-5674																
H9438	002	0	1	20	08	H9438_002_0	1	1				05/23/2018	2019.01	05/23/2018 08:56:19 AM Central Daylight Time		05/23/2018 08:48:33 AM Central Daylight Time			05/23/2018 08:58:16 AM Central Daylight Time	BLUESTEM PACE, INC.	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	08	20		1			H9438	002	0	2019	Counties:  RC, HV, RN, MN, MP, SA, EW, DK, OT, LC		2		2			2						NA	NA										(844)588-7223		(620)504-5900		(844)588-7223		(620)504-5900												(620)504-5900				(620)504-5900																
H9455	001	0	1	01	01	H9455_001_0	12	1	2	1		07/19/2018	2019.01	07/19/2018 04:37:49 PM Pacific Daylight Time	08/07/2018 10:16:30 AM Pacific Daylight Time	08/07/2018 10:16:32 AM Pacific Daylight Time			08/07/2018 10:22:55 AM Pacific Daylight Time	HEALTH CHOICE UTAH, INC.	Steward Health Choice Generations (HMO SNP)	www.healthchoicegenerations.com	Steward Health Choice Generations (HMO SNP)	01	01		1			H9455	001	0	2019	Salt Lake, Utah, Davis, Weber, Tooele		2		2			1	3		2		1	www.hcgenerations.com	www.healthchoicegenerations.com	http://www.healthchoiceutah.com	(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9460	001	0	1	01	01	H9460_001_0	4	1				08/02/2018	2019.01	08/02/2018 05:33:17 PM Central Daylight Time	08/03/2018 08:45:58 AM Central Daylight Time	07/31/2018 08:54:25 PM Central Daylight Time			08/06/2018 12:02:51 PM Central Daylight Time	CIGNA HEALTHCARE OF ST LOUIS, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H9460	001	0	2019	Select Counties in Kansas and Missouri		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9460	002	0	1	01	01	H9460_002_0	3	1				07/20/2018	2019.01	07/20/2018 03:44:58 PM Central Daylight Time	07/16/2018 10:41:31 AM Central Daylight Time				07/21/2018 10:14:12 PM Central Daylight Time	CIGNA HEALTHCARE OF ST LOUIS, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H9460	002	0	2019	Select Counties in Kansas and Missouri		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9487	001	0	1	48	05	H9487_001_0	6	1				08/30/2018	2019.01	08/30/2018 08:26:42 AM Eastern Daylight Time					08/30/2018 04:39:01 PM Pacific Daylight Time	MICHIGAN COMPLETE HEALTH, INC.	Michigan Complete Health	mmp.michigancompletehealth.com	Michigan Complete Health (Medicare-Medicaid Plan)	05	48		1			H9487	001	0	2019	Wayne and Macomb Counties		2	34687	2			2						mmp.michigancompletehealth.com/mmp/benefits/find-a-doctor-or-pharmacy.html	mmp.michigancompletehealth.com/mmp/prescription-drug-part-d/formulary.html	mmp.michigancompletehealth.com/mmp/benefits/find-a-doctor-or-pharmacy.html	(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9516	001	0	1	04	01	H9516_001_0	11	1				07/06/2018	2019.01	07/06/2018 08:37:16 PM Central Daylight Time	08/02/2018 01:41:12 PM Central Daylight Time	08/02/2018 11:17:28 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Flex (PPO)	01	04		1			H9516	001	0	2019	Kings, Queens, and New York Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9516	002	0	1	04	01	H9516_002_0	11	1				07/06/2018	2019.01	07/06/2018 08:38:02 PM Central Daylight Time	08/02/2018 01:42:04 PM Central Daylight Time	08/02/2018 11:18:12 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Flex Plus (PPO)	01	04		1			H9516	002	0	2019	Kings, Queens, and New York Counties		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9525	003	0	1	01	01	H9525_003_0	10	1	2	1		08/03/2018	2019.01	08/03/2018 10:49:20 AM Eastern Daylight Time	08/06/2018 02:05:44 AM Eastern Daylight Time	08/01/2018 08:29:39 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H9525	003	0	2019	Select Counties in Wisconsin		2	23904	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)242-0251		(866)242-0251		(844)788-9046		(844)788-9046		(866)242-0251		(866)242-0251		(844)788-9047		(844)788-9047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	004	0	1	01	01	H9525_004_0	11	1				08/03/2018	2019.01	08/03/2018 10:49:46 AM Eastern Daylight Time	08/06/2018 02:06:45 AM Eastern Daylight Time	08/01/2018 08:45:20 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	01	01		1			H9525	004	0	2019	Select Counties in Wisconsin		2	52548	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1774		(855)304-1774		(844)364-2130		(844)364-2130		(855)304-1774		(855)304-1774		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	006	0	1	01	01	H9525_006_0	11	1				08/03/2018	2019.01	08/03/2018 10:50:09 AM Eastern Daylight Time	08/06/2018 02:07:45 AM Eastern Daylight Time	08/01/2018 08:46:02 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	01	01		1			H9525	006	0	2019	Select Counties in Wisconsin		2	42108	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1774		(855)304-1774		(844)364-2130		(844)364-2130		(855)304-1774		(855)304-1774		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	007	0	1	01	01	H9525_007_0	10	1	2	1		08/03/2018	2019.01	08/03/2018 10:50:57 AM Eastern Daylight Time	08/06/2018 02:08:46 AM Eastern Daylight Time	08/01/2018 08:30:59 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H9525	007	0	2019	Select Counties in Kentucky		2	59976	2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(844)788-9046		(844)788-9046		(844)879-3601		(844)879-3601		(844)788-9047		(844)788-9047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	008	0	1	01	01	H9525_008_0	11	1				08/03/2018	2019.01	08/03/2018 10:50:35 AM Eastern Daylight Time	08/06/2018 02:09:47 AM Eastern Daylight Time	08/01/2018 08:46:44 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com	Anthem MediBlue Plus (HMO)	01	01		1			H9525	008	0	2019	Select Counties in Kentucky		2	256620	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)558-1439		(855)558-1439		(844)364-2130		(844)364-2130		(855)558-1439		(855)558-1439		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	801	0	1	01	01	H9525_801_0	2	1				06/19/2018	2019.01	06/19/2018 03:28:54 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	801	0	2019	Wisconsin select counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	802	0	1	01	01	H9525_802_0	2	1				06/19/2018	2019.01	06/19/2018 03:29:49 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	802	0	2019	Select counties in Wisconsin		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	803	0	2	01	01	H9525_803_0	2	1				06/19/2018	2019.01	06/19/2018 03:30:21 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		2	1		H9525	803	0	2019	Wisconsin - Select Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	804	0	1	01	01	H9525_804_0	2	1				06/19/2018	2019.01	06/19/2018 03:31:35 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		1			H9525	804	0	2019	Kentucky - Select Counties		1	216	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	805	0	1	01	01	H9525_805_0	2	1				06/19/2018	2019.01	06/19/2018 03:34:41 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		1			H9525	805	0	2019	Kentucky - Select Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	806	0	2	01	01	H9525_806_0	2	1				06/19/2018	2019.01	06/19/2018 03:34:52 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H9525	806	0	2019	Kentucky - Select Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	807	0	2	01	01	H9525_807_0	2	1				06/19/2018	2019.01	06/19/2018 03:35:32 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		2	1		H9525	807	0	2019	Select Wisconsin Coutnies		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	808	0	1	01	01	H9525_808_0	2	1				06/19/2018	2019.01	06/19/2018 03:37:45 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	808	0	2019	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	809	0	1	01	01	H9525_809_0	2	1				06/19/2018	2019.01	06/19/2018 03:37:53 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	809	0	2019	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	810	0	2	01	01	H9525_810_0	2	1				06/19/2018	2019.01	06/19/2018 03:38:25 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		2	1		H9525	810	0	2019	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	811	0	2	01	01	H9525_811_0	2	1				06/19/2018	2019.01	06/19/2018 03:44:48 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H9525	811	0	2019	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	812	0	1	01	01	H9525_812_0	2	1				06/19/2018	2019.01	06/19/2018 03:41:40 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		1			H9525	812	0	2019	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	813	0	1	01	01	H9525_813_0	2	1				06/19/2018	2019.01	06/19/2018 03:44:32 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		1			H9525	813	0	2019	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	814	0	2	01	01	H9525_814_0	2	1				06/19/2018	2019.01	06/19/2018 03:42:51 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H9525	814	0	2019	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	815	0	2	01	01	H9525_815_0	2	1				06/19/2018	2019.01	06/19/2018 03:44:26 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	01	01		2	1		H9525	815	0	2019	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	816	0	2	01	01	H9525_816_0	2	1				06/19/2018	2019.01	06/19/2018 03:44:13 PM Pacific Daylight Time					06/19/2018 04:34:34 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	01	01		2	1		H9525	816	0	2019	Select  KY Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9572	001	1	1	04	01	H9572_001_1	4	1				07/01/2018	2019.01	07/01/2018 06:01:51 PM Eastern Daylight Time	08/03/2018 03:14:56 PM Eastern Daylight Time	08/01/2018 11:17:09 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	1	2019	State of Michigan	Region 1	2	15771	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	2	1	04	01	H9572_001_2	4	1				07/01/2018	2019.01	07/01/2018 06:02:03 PM Eastern Daylight Time	08/03/2018 03:15:53 PM Eastern Daylight Time	08/01/2018 11:17:37 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	2	2019	State of Michigan	Region 2	2	41517	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	3	1	04	01	H9572_001_3	4	1				07/01/2018	2019.01	07/01/2018 05:45:50 PM Eastern Daylight Time	08/03/2018 03:16:52 PM Eastern Daylight Time	08/01/2018 11:18:07 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	3	2019	State of Michigan	Region 3	2	48812	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	4	1	04	01	H9572_001_4	4	1				07/01/2018	2019.01	07/01/2018 05:46:11 PM Eastern Daylight Time	08/03/2018 03:17:51 PM Eastern Daylight Time	08/01/2018 11:18:36 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	4	2019	State of Michigan	Region 4	2	84882	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	6	1	04	01	H9572_001_6	4	1				07/01/2018	2019.01	07/01/2018 06:02:24 PM Eastern Daylight Time	08/03/2018 03:18:47 PM Eastern Daylight Time	08/01/2018 11:19:07 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	6	2019	State of Michigan	Region 6	2	283062	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	1	1	04	01	H9572_002_1	4	1				07/01/2018	2019.01	07/01/2018 05:46:37 PM Eastern Daylight Time	08/06/2018 09:12:50 AM Eastern Daylight Time	08/01/2018 11:19:36 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	1	2019	State of Michigan	Region 1	2	12161	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	2	1	04	01	H9572_002_2	4	1				07/01/2018	2019.01	07/01/2018 05:48:11 PM Eastern Daylight Time	08/06/2018 09:13:47 AM Eastern Daylight Time	08/01/2018 11:20:06 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	2	2019	State of Michigan	Region 2	2	26425	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	3	1	04	01	H9572_002_3	4	1				07/01/2018	2019.01	07/01/2018 05:48:27 PM Eastern Daylight Time	08/06/2018 09:14:45 AM Eastern Daylight Time	08/01/2018 11:20:36 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	3	2019	State of Michigan	Region 3	2	25640	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	4	1	04	01	H9572_002_4	4	1				07/01/2018	2019.01	07/01/2018 05:48:41 PM Eastern Daylight Time	08/06/2018 09:15:43 AM Eastern Daylight Time	08/01/2018 11:21:06 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	4	2019	State of Michigan	Region 4	2	59303	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	6	1	04	01	H9572_002_6	4	1				07/01/2018	2019.01	07/01/2018 05:47:21 PM Eastern Daylight Time	08/06/2018 09:16:40 AM Eastern Daylight Time	08/01/2018 11:21:37 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	6	2019	State of Michigan	Region 6	2	79980	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	1	1	04	01	H9572_003_1	4	1				07/01/2018	2019.01	07/01/2018 05:49:10 PM Eastern Daylight Time	08/03/2018 03:24:34 PM Eastern Daylight Time	08/01/2018 11:22:07 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	1	2019	State of Michigan	Region 1	2	7803	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	2	1	04	01	H9572_003_2	4	1				07/01/2018	2019.01	07/01/2018 05:51:34 PM Eastern Daylight Time	08/03/2018 03:25:31 PM Eastern Daylight Time	08/01/2018 11:22:36 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	2	2019	State of Michigan	Region 2	2	15982	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	3	1	04	01	H9572_003_3	4	1				07/01/2018	2019.01	07/01/2018 05:51:46 PM Eastern Daylight Time	08/03/2018 03:26:29 PM Eastern Daylight Time	08/01/2018 11:23:06 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	3	2019	State of Michigan	Region 3	2	10060	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	4	1	04	01	H9572_003_4	4	1				07/01/2018	2019.01	07/01/2018 05:52:05 PM Eastern Daylight Time	08/03/2018 03:27:30 PM Eastern Daylight Time	08/01/2018 11:23:36 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	4	2019	State of Michigan	Region 4	2	28259	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	6	1	04	01	H9572_003_6	4	1				07/01/2018	2019.01	07/01/2018 05:50:19 PM Eastern Daylight Time	08/03/2018 03:28:29 PM Eastern Daylight Time	08/01/2018 11:24:05 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	6	2019	State of Michigan	Region 6	2	51976	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	1	1	04	01	H9572_004_1	4	1				07/01/2018	2019.01	07/01/2018 05:52:21 PM Eastern Daylight Time	08/03/2018 03:29:26 PM Eastern Daylight Time	08/01/2018 11:24:34 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	1	2019	State of Michigan	Region 1	2	5651	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	2	1	04	01	H9572_004_2	4	1				06/28/2018	2019.01	06/28/2018 08:01:58 PM Eastern Daylight Time	08/03/2018 03:30:26 PM Eastern Daylight Time	08/01/2018 11:25:04 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	2	2019	State of Michigan	Region 2	2	25429	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	3	1	04	01	H9572_004_3	4	1				06/28/2018	2019.01	06/28/2018 08:02:24 PM Eastern Daylight Time	08/03/2018 03:31:26 PM Eastern Daylight Time	08/01/2018 11:25:34 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	3	2019	State of Michigan	Region 3	2	34949	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	4	1	04	01	H9572_004_4	4	1				07/01/2018	2019.01	07/01/2018 05:51:20 PM Eastern Daylight Time	08/03/2018 03:32:24 PM Eastern Daylight Time	08/01/2018 11:26:04 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	4	2019	State of Michigan	Region 4	2	68827	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	6	1	04	01	H9572_004_6	4	1				07/01/2018	2019.01	07/01/2018 05:16:31 PM Eastern Daylight Time	08/03/2018 03:33:21 PM Eastern Daylight Time	08/01/2018 11:26:34 AM Eastern Daylight Time			08/06/2018 05:04:39 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	6	2019	State of Michigan	Region 6	2	112699	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	801	0	1	04	01	H9572_801_0	3	1				06/18/2018	2019.01	06/18/2018 04:45:38 PM Eastern Daylight Time					06/19/2018 08:44:55 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer Rx CY (PPO)	01	04		1			H9572	801	0	2019	State of Michigan		1	355245	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	802	0	1	04	01	H9572_802_0	3	1				06/18/2018	2019.01	06/18/2018 04:43:02 PM Eastern Daylight Time					06/19/2018 08:44:55 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer CY (PPO)	01	04		1			H9572	802	0	2019	State of Michigan		1	3977007	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	803	0	1	04	01	H9572_803_0	2	1				05/04/2018	2019.01	05/04/2018 04:04:32 PM Eastern Daylight Time					06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer Rx non-CY (PPO)	01	04		1			H9572	803	0	2019	State of Michigan		1	1200	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	804	0	1	04	01	H9572_804_0	2	1				05/04/2018	2019.01	05/04/2018 04:04:41 PM Eastern Daylight Time					06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer non-CY (PPO)	01	04		1			H9572	804	0	2019	State of Michigan		1	1200	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	805	0	1	04	01	H9572_805_0	2	1				05/31/2018	2019.01	05/31/2018 03:06:19 PM Eastern Daylight Time					06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer CY ASC (PPO)	01	04		1			H9572	805	0	2019	State of Michigan		1	1200	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9576	001	0	1	48	05	H9576_001_0	3	1				07/29/2018	2019.01	07/29/2018 10:20:03 PM Eastern Daylight Time					07/29/2018 10:20:15 PM Eastern Daylight Time	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	www.nhpri.org/INTEGRITY	Neighborhood INTEGRITY (Medicare-Medicaid Plan)	05	48		1			H9576	001	0	2019	State of Rhode Island		2	182361	2			2						www.nhpri.org/INTEGRITY	www.nhpri.org/INTEGRITY	www.nhpri.org/INTEGRITY	(844)812-6896		(401)427-8181		(844)812-6896		(401)427-8181		(844)812-6896		(401)427-8181		(844)812-6896		(401)427-8181		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9585	001	0	1	01	01	H9585_001_0	7	1	2	1		08/07/2018	2019.01	08/07/2018 02:48:35 PM Eastern Daylight Time	08/06/2018 06:13:02 PM Eastern Daylight Time	08/02/2018 09:34:50 AM Eastern Daylight Time			08/07/2018 02:48:56 PM Eastern Daylight Time	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	BMC HealthNet Plan Senior Care Options	www.SeniorsGetMore.org	BMC HealthNet Plan Senior Care Options (HMO SNP)	01	01		1			H9585	001	0	2019	Barnstable, Bristol, Hampden, Plymouth, Suffolk		2		2			1	3		1		1	www.SeniorsGetMore.org/pharmacy	www.SeniorsGetMore.org/pharmacy	www.SeniorsGetMore.org	(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9589	001	0	1	04	01	H9589_001_0	6	1		1		07/05/2018	2019.01	07/05/2018 01:22:48 PM Eastern Daylight Time	08/03/2018 09:08:07 AM Eastern Daylight Time	08/03/2018 09:59:20 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (GA)	Eon Health	www.eonhealthplan.com	EON GOLD (PPO SNP)	01	04		1			H9589	001	0	2019	Select Georgia Counties		2		2			1	4			00000000000000000010		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9589	003	0	1	04	01	H9589_003_0	7	1				08/07/2018	2019.01	08/07/2018 03:00:16 PM Eastern Daylight Time	08/03/2018 09:05:46 AM Eastern Daylight Time	08/03/2018 09:58:38 AM Eastern Daylight Time			08/07/2018 03:02:00 PM Eastern Daylight Time	EON HEALTH, INC. (GA)	Eon Health	www.eonhealthplan.com	EON CHOICE (PPO)	01	04		1			H9589	003	0	2019	Select Georgia Counties		2		2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9590	001	0	1	01	01	H9590_001_0	3	1		1		08/03/2018	2019.01	08/03/2018 09:59:06 AM Eastern Daylight Time	08/07/2018 02:52:17 PM Eastern Daylight Time	08/07/2018 02:52:17 PM Eastern Daylight Time			08/07/2018 02:59:38 PM Eastern Daylight Time	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Longevity Health Plan (HMO SNP)	www.longevityhealthplan.com	Longevity Health Plan (HMO SNP)	01	01		1			H9590	001	0	2019	Illinois (partial)		2	2041	2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9592	001	0	1	20	08	H9592_001_0	2	1				05/29/2018	2019.01	05/29/2018 09:16:38 AM Pacific Daylight Time		05/29/2018 09:25:32 AM Pacific Daylight Time			05/29/2018 09:27:31 AM Pacific Daylight Time	CENTRAL VALLEY MEDICAL SERVICES CORPORATION	Fresno PACE	www.fresnopace.org	Fresno PACE (PACE)	08	20		1			H9592	001	0	2019	Fresno County Area		2		2			2						www.fresnopace.org	www.pharmastarpbm.com/										(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223										(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223																
H9592	002	0	1	20	08	H9592_002_0	2	1				05/29/2018	2019.01	05/29/2018 09:16:52 AM Pacific Daylight Time		05/29/2018 09:25:53 AM Pacific Daylight Time			05/29/2018 09:27:31 AM Pacific Daylight Time	CENTRAL VALLEY MEDICAL SERVICES CORPORATION	Fresno PACE	www.fresnopace.org	Fresno PACE (PACE)	08	20		1			H9592	002	0	2019	Fresno County Area		2		2			2						www.fresnopace.org	www.pharmastarpbm.com/										(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223										(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223																
H9615	007	0	1	04	01	H9615_007_0	7	1				07/12/2018	2019.01	07/12/2018 09:40:35 AM Eastern Daylight Time	08/01/2018 03:42:08 PM Eastern Daylight Time	08/01/2018 02:17:24 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Gold PPO with Part D (PPO)	01	04		1			H9615	007	0	2019	Central NY, Eastern NY, Vermont		2	10445	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	008	0	1	04	01	H9615_008_0	7	1				07/12/2018	2019.01	07/12/2018 09:41:03 AM Eastern Daylight Time	08/01/2018 03:59:24 PM Eastern Daylight Time	08/03/2018 04:28:10 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	WellSelect with Part D (PPO)	01	04		1			H9615	008	0	2019	Central NY, Eastern NY, Vermont		2	34493	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	009	0	1	04	01	H9615_009_0	7	1				07/12/2018	2019.01	07/12/2018 09:41:33 AM Eastern Daylight Time	08/01/2018 04:02:10 PM Eastern Daylight Time	08/01/2018 02:21:56 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Gold PPO with Part D (PPO)	01	04		1			H9615	009	0	2019	Hudson Valley NY		2	6264	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	010	0	1	04	01	H9615_010_0	7	1				07/12/2018	2019.01	07/12/2018 09:42:29 AM Eastern Daylight Time	08/01/2018 04:04:04 PM Eastern Daylight Time	08/03/2018 04:27:14 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	WellSelect with Part D (PPO)	01	04		1			H9615	010	0	2019	Hudson Valley NY		2	26510	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	012	0	1	04	01	H9615_012_0	7	1				07/12/2018	2019.01	07/12/2018 09:42:56 AM Eastern Daylight Time	08/01/2018 04:05:36 PM Eastern Daylight Time	08/03/2018 04:26:22 PM Eastern Daylight Time			08/03/2018 05:52:28 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	WellSelect with Part D (PPO)	01	04		1			H9615	012	0	2019	Western NY (Rochester/Buffalo)		2	49948	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	802	0	1	04	01	H9615_802_0	1	1				04/25/2018	2019.01	04/25/2018 02:51:35 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	GoldAnywhere Rx - Employer Group (PPO)	01	04		1			H9615	802	0	2019	Employer Group East/West		1	130044	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9615	807	0	1	04	01	H9615_807_0	1	1				04/25/2018	2019.01	04/25/2018 02:52:25 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	USA Care Rx - Employer Group (PPO)	01	04		1			H9615	807	0	2019	United States and Puerto Rico		1	26555	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9615	810	0	1	04	01	H9615_810_0	1	1				04/25/2018	2019.01	04/25/2018 02:53:37 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	GoldAnywhere - Employer Group (PPO)	01	04		1			H9615	810	0	2019	Western NY, Central NY, Eastern NY, Vermont		1	1500	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9615	811	0	1	04	01	H9615_811_0	1	1				04/25/2018	2019.01	04/25/2018 02:54:22 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	USA Care without Part D - Employer Group (PPO)	01	04		1			H9615	811	0	2019	United States and Puerto Rico		1	300	2			2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9616	001	0	1	20	08	H9616_001_0	1	1				06/01/2018	2019.01	06/01/2018 01:27:57 PM Pacific Daylight Time		06/01/2018 01:13:46 PM Pacific Daylight Time			06/01/2018 01:29:58 PM Pacific Daylight Time	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	San Diego PACE	http://www.syhc.org/sdpace/	San Diego PACE (Duals) (PACE)	08	20		1			H9616	001	0	2019	San Diego County		2		2			2						http://www.syhc.org/services/senior-services/san-diego-pace/	http://www.syhc.org/services/senior-services/san-diego-pace/										(844)473-7223		(619)205-4585		(844)473-7223		(619)205-4585										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H9616	002	0	1	20	08	H9616_002_0	1	1				06/01/2018	2019.01	06/01/2018 01:28:30 PM Pacific Daylight Time		06/01/2018 01:15:10 PM Pacific Daylight Time			06/01/2018 01:29:58 PM Pacific Daylight Time	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	San Diego PACE	http://www.syhc.org/sdpace/	San Diego PACE (Medicare Only) (PACE)	08	20		1			H9616	002	0	2019	San Diego County		2		2			2						http://www.syhc.org/services/senior-services/san-diego-pace/	http://www.syhc.org/services/senior-services/san-diego-pace/										(844)473-7223		(619)205-4585		(844)473-7223		(619)205-4585										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H9630	001	0	1	01	01	H9630_001_0	4	1				08/03/2018	2019.01	08/03/2018 11:17:30 AM Pacific Daylight Time	08/04/2018 02:09:24 PM Pacific Daylight Time	08/04/2018 02:11:43 PM Pacific Daylight Time			08/04/2018 02:22:28 PM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Medicare (HMO)	01	01		1			H9630	001	0	2019	Northwest Arkansas		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	002	0	1	01	01	H9630_002_0	6	1				08/03/2018	2019.01	08/03/2018 11:17:35 AM Pacific Daylight Time	08/06/2018 08:07:06 AM Pacific Daylight Time	08/06/2018 08:07:01 AM Pacific Daylight Time			08/06/2018 04:53:39 PM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Medicare (HMO)	01	01		1			H9630	002	0	2019	Little Rock Area		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	003	0	1	01	01	H9630_003_0	6	1				08/03/2018	2019.01	08/03/2018 11:17:39 AM Pacific Daylight Time	08/06/2018 08:06:49 AM Pacific Daylight Time	08/06/2018 08:06:56 AM Pacific Daylight Time			08/06/2018 04:53:39 PM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Medicare Select (HMO)	01	01		1			H9630	003	0	2019	Benton, Washington		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	004	0	1	01	01	H9630_004_0	4	1				08/03/2018	2019.01	08/03/2018 11:17:46 AM Pacific Daylight Time	08/04/2018 02:17:50 PM Pacific Daylight Time	08/04/2018 02:18:57 PM Pacific Daylight Time			08/04/2018 02:22:28 PM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Medicare (HMO)	01	01		1			H9630	004	0	2019	Northern AR Counties		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	005	0	1	01	01	H9630_005_0	4	1				08/03/2018	2019.01	08/03/2018 11:21:33 AM Pacific Daylight Time	08/06/2018 10:44:09 AM Pacific Daylight Time	08/06/2018 10:44:18 AM Pacific Daylight Time			08/06/2018 10:45:06 AM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Medicare Premier (HMO)	01	01		1			H9630	005	0	2019	Northern AR Counties		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	801	0	1	01	01	H9630_801_0	1	1				05/29/2018	2019.01	05/29/2018 05:30:57 PM Pacific Daylight Time					06/03/2018 03:39:16 PM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	01	01		1			H9630	801	0	2019	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/find-doctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9630	802	0	1	01	01	H9630_802_0	1	1				05/29/2018	2019.01	05/29/2018 05:30:54 PM Pacific Daylight Time					06/03/2018 03:39:16 PM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	01	01		1			H9630	802	0	2019	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/find-doctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9630	803	0	1	01	01	H9630_803_0	1	1				05/29/2018	2019.01	05/29/2018 04:48:35 PM Pacific Daylight Time					06/03/2018 03:39:16 PM Pacific Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	01	01		1			H9630	803	0	2019	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/find-doctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9699	004	1	1	01	01	H9699_004_1	8	1				08/07/2018	2019.01	08/07/2018 07:27:43 AM Central Daylight Time	08/07/2018 07:22:28 AM Central Daylight Time	08/07/2018 07:22:29 AM Central Daylight Time			08/07/2018 07:29:05 AM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Medi-Pak Advantage (HMO)	01	01		1			H9699	004	1	2019	State of Arkansas	Northwest and West Central AR counties	2	38044	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	004	2	1	01	01	H9699_004_2	8	1				08/06/2018	2019.01	08/06/2018 01:41:43 PM Central Daylight Time	08/07/2018 07:22:31 AM Central Daylight Time	08/07/2018 07:22:31 AM Central Daylight Time			08/07/2018 07:29:05 AM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Medi-Pak Advantage (HMO)	01	01		1			H9699	004	2	2019	State of Arkansas	East Central AR counties	2	23545	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	004	3	1	01	01	H9699_004_3	8	1				08/06/2018	2019.01	08/06/2018 01:41:57 PM Central Daylight Time	08/07/2018 07:22:32 AM Central Daylight Time	08/07/2018 07:22:33 AM Central Daylight Time			08/07/2018 07:29:05 AM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Medi-Pak Advantage (HMO)	01	01		1			H9699	004	3	2019	State of Arkansas	Central AR counties	2	8743	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9712	001	0	1	48	05	H9712_001_0	10	1				08/30/2018	2019.01	08/30/2018 05:52:26 PM Eastern Daylight Time					08/30/2018 05:55:36 PM Eastern Daylight Time	HAP MIDWEST HEALTH PLAN, INC.	HAP Midwest MI Health Link	www.midwesthealthplan.com/mihealthlink	HAP Empowered MI Health Link (Medicare-Medicaid Plan)	05	48		1			H9712	001	0	2019	HAP Midwest MI Health Link		2		1	1		2						www.midwesthealthplan.com/mihealthlink	www.midwesthealthplan.com/mihealthlink	www.midwesthealthplan.com/mihealthlink	(888)654-0706		(248)663-3800		(888)654-0706		(248)663-3800		(888)445-5580		(248)663-3800		(888)654-0706		(248)663-3800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9725	001	0	1	01	01	H9725_001_0	4	1				08/01/2018	2019.01	08/01/2018 05:12:11 PM Central Daylight Time	08/03/2018 05:15:09 PM Central Daylight Time	07/31/2018 08:54:39 PM Central Daylight Time			08/06/2018 12:07:18 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Direct (HMO)	01	01		1			H9725	001	0	2019	Select North Carolina Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	003	0	1	01	01	H9725_003_0	4	1	2	1		08/01/2018	2019.01	08/01/2018 05:12:30 PM Central Daylight Time	08/03/2018 05:15:33 PM Central Daylight Time	07/31/2018 08:54:53 PM Central Daylight Time			08/06/2018 12:07:18 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare Direct (HMO SNP)	01	01		1			H9725	003	0	2019	Select North Carolina Counties		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	005	0	1	01	01	H9725_005_0	3	1				05/29/2018	2019.01	05/29/2018 06:41:21 PM Central Daylight Time	07/16/2018 10:45:49 AM Central Daylight Time				07/19/2018 12:21:25 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage Direct (HMO)	01	01		1			H9725	005	0	2019	Select North Carolina Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9725	006	0	1	01	01	H9725_006_0	4	1				08/01/2018	2019.01	08/01/2018 05:12:52 PM Central Daylight Time	08/03/2018 05:15:56 PM Central Daylight Time	07/31/2018 08:55:06 PM Central Daylight Time			08/06/2018 12:07:18 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus Direct (HMO)	01	01		1			H9725	006	0	2019	Select North Carolina Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	801	0	1	01	01	H9725_801_0	2	1				05/22/2018	2019.01	05/22/2018 04:56:56 PM Central Daylight Time					05/31/2018 04:01:36 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H9725	801	0	2019	North Carolina		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1					1				
H9725	807	0	1	02	01	H9725_807_0	2	1				05/22/2018	2019.01	05/22/2018 04:59:36 PM Central Daylight Time					05/31/2018 04:01:36 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H9725	807	0	2019	North Carolina		1	6000	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;16b;	2		1				
H9730	002	0	1	01	01	H9730_002_0	3	1				08/03/2018	2019.01	08/03/2018 12:37:13 PM Eastern Daylight Time	08/06/2018 06:02:34 PM Eastern Daylight Time	08/01/2018 02:50:06 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H9730	002	0	2019	Select Counties in KY		2	33730	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)560-2766		(877)560-2766		(866)527-0056		(866)527-0056		(877)560-2766		(877)560-2766		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	003	0	1	01	01	H9730_003_0	3	1	2	1		05/22/2018	2019.01	05/22/2018 08:31:39 AM Eastern Daylight Time	08/06/2018 06:03:17 PM Eastern Daylight Time	08/01/2018 02:50:27 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H9730	003	0	2019	Select Counties in KY		2	51782	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)560-3206		(877)560-3206		(866)527-0056		(866)527-0056		(877)560-3206		(877)560-3206		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	004	0	1	01	01	H9730_004_0	3	1	2	1		05/22/2018	2019.01	05/22/2018 08:39:30 AM Eastern Daylight Time	08/06/2018 06:04:01 PM Eastern Daylight Time	08/01/2018 02:50:48 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H9730	004	0	2019	Select KY Counties		2	28080	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)560-3206		(877)560-3206		(866)527-0056		(866)527-0056		(877)560-3206		(877)560-3206		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	005	0	1	02	01	H9730_005_0	3	1				08/03/2018	2019.01	08/03/2018 12:36:30 PM Eastern Daylight Time	08/06/2018 06:04:43 PM Eastern Daylight Time	08/01/2018 02:51:09 PM Eastern Daylight Time			08/07/2018 01:35:38 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H9730	005	0	2019	Selected KY Counties		2	64444	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)560-2766		(877)560-2766		(866)527-0056		(866)527-0056		(877)560-2766		(877)560-2766		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	006	0	1	02	01	H9730_006_0	2	1				05/30/2018	2019.01	05/30/2018 07:26:24 PM Eastern Daylight Time	06/02/2018 03:43:20 AM Eastern Daylight Time				06/02/2018 10:07:17 AM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	01	02		1			H9730	006	0	2019	Select Counties in KY		2	2101	2			2						www.wellcare.com/our_pharmacies	www.wellcare.com/medicare/medication_guide	www.wellcare.com/fap_search	(877)560-2766		(877)560-2766		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9808	004	0	1	04	01	H9808_004_0	7	1				08/07/2018	2019.01	08/07/2018 09:34:16 AM Eastern Daylight Time	08/02/2018 02:18:41 PM Eastern Daylight Time	08/01/2018 11:59:19 AM Eastern Daylight Time			08/07/2018 11:05:03 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	HealthTeam Advantage	www.healthteamadvantage.com	HealthTeam Advantage Plan I (PPO)	01	04		1			H9808	004	0	2019	AL GL RA RO FOR		2	211000	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	005	0	1	04	01	H9808_005_0	7	1				08/07/2018	2019.01	08/07/2018 09:34:42 AM Eastern Daylight Time	08/02/2018 02:22:54 PM Eastern Daylight Time	08/01/2018 12:02:35 PM Eastern Daylight Time			08/07/2018 11:05:03 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	HealthTeam Advantage	www.healthteamadvantage.com	HealthTeam Advantage Plan II (PPO)	01	04		1			H9808	005	0	2019	AL GL RA RO FOR		2	21000	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	006	0	1	04	01	H9808_006_0	7	1				08/07/2018	2019.01	08/07/2018 09:34:56 AM Eastern Daylight Time	08/02/2018 02:27:28 PM Eastern Daylight Time	08/01/2018 12:47:18 PM Eastern Daylight Time			08/07/2018 11:05:03 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	HealthTeam Advantage	www.healthteamadvantage.com	Atrium I (PPO)	01	04		1			H9808	006	0	2019	AN BU CL LN ST UN		2	21000	2			2						Healthteamadvantage.com	Healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	007	0	1	04	01	H9808_007_0	7	1				08/07/2018	2019.01	08/07/2018 09:35:15 AM Eastern Daylight Time	08/02/2018 02:30:10 PM Eastern Daylight Time	08/01/2018 12:53:13 PM Eastern Daylight Time			08/07/2018 11:05:03 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	HealthTeam Advantage	www.healthteamadvantage.com	Atrium II (PPO)	01	04		1			H9808	007	0	2019	AN BU CL LN ST UN		2	2000	2			2						Healthteamadvantage.com	Healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	804	0	1	04	01	H9808_804_0	2	1				04/25/2018	2019.01	04/25/2018 12:56:07 PM Eastern Daylight Time					06/04/2018 02:45:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	HealthTeam Advantage	www.healthteamadvantage.com	HealthTeam Advantage Employer Group NCY (PPO)	01	04		1			H9808	804	0	2019	AL GL RA RO FOR		1	1	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	805	0	1	04	01	H9808_805_0	2	1				04/25/2018	2019.01	04/25/2018 12:57:23 PM Eastern Daylight Time					06/04/2018 02:45:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	HealthTeam Advantage	www.healthteamadvantage.com	Atrium Employer Plan (PPO)	01	04		1			H9808	805	0	2019	AN BU CL LN ST UN		1	1	2			2						Healthteamadvantage.com	Healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(888)965-1965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9811	001	0	1	01	01	H9811_001_0	7	1				08/01/2018	2019.01	08/01/2018 11:14:27 AM Pacific Daylight Time	08/06/2018 08:58:06 AM Pacific Daylight Time	08/04/2018 10:20:44 AM Pacific Daylight Time			08/06/2018 09:13:21 AM Pacific Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Allwell	allwell.magnoliahealthplan.com	Allwell Medicare (HMO)	01	01		1			H9811	001	0	2019	George, Harr, Hinds, Jackson, Mad, Rankin, Stone		2		2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	005	0	1	01	01	H9811_005_0	6	1				08/01/2018	2019.01	08/01/2018 11:15:23 AM Pacific Daylight Time	08/06/2018 08:58:08 AM Pacific Daylight Time	08/04/2018 10:20:44 AM Pacific Daylight Time			08/06/2018 09:13:21 AM Pacific Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Allwell	allwell.magnoliahealthplan.com	Allwell Medicare (HMO)	01	01		1			H9811	005	0	2019	DeSoto, Lafayette, Panola and Tate counties		2		2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	006	0	1	01	01	H9811_006_0	6	1	2	1		08/06/2018	2019.01	08/06/2018 11:32:15 AM Pacific Daylight Time	08/06/2018 03:14:38 PM Pacific Daylight Time	08/04/2018 10:20:44 AM Pacific Daylight Time			08/06/2018 03:20:42 PM Pacific Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Allwell	allwell.magnoliahealthplan.com	Allwell Dual Medicare (HMO SNP)	01	01		1			H9811	006	0	2019	George, Harr, Hinds, Jackson, Mad, Rankin, Stone		2		2			1	3		1		1	allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	801	0	1	01	01	H9811_801_0	2	1				05/29/2018	2019.01	05/29/2018 04:49:02 PM Pacific Daylight Time					06/04/2018 03:02:34 PM Pacific Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	801	0	2019	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9811	802	0	1	01	01	H9811_802_0	2	1				05/29/2018	2019.01	05/29/2018 04:49:17 PM Pacific Daylight Time					06/04/2018 03:02:34 PM Pacific Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	802	0	2019	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9811	803	0	1	01	01	H9811_803_0	2	1				05/29/2018	2019.01	05/29/2018 05:31:03 PM Pacific Daylight Time					06/04/2018 03:02:34 PM Pacific Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	803	0	2019	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9830	001	0	1	20	08	H9830_001_0	3	1				05/30/2018	2019.01	05/30/2018 02:05:10 PM Eastern Daylight Time		05/30/2018 01:54:46 PM Eastern Daylight Time			05/30/2018 02:08:01 PM Eastern Daylight Time	NEWCOURTLAND LIFE PROGRAM	NewCourtland LIFE Program	www.newcourtlandlife.org	NewCourtland LIFE  - Dual (PACE)	08	20		1			H9830	001	0	2019	NewCourtland LIFE - North, NW, NE Phila Svc Area		2		2			2						http://www.medicineshoppe.com/FranchiseeLocations/1024/SpecialServices.aspx	N/A										(888)530-4913		(215)951-4400		(888)530-4913		(215)951-4400										(888)530-4913		(267)335-1500		(888)530-4913		(267)335-1500																
H9830	002	0	1	20	08	H9830_002_0	3	1				05/30/2018	2019.01	05/30/2018 02:05:25 PM Eastern Daylight Time		05/30/2018 01:54:32 PM Eastern Daylight Time			05/30/2018 02:08:01 PM Eastern Daylight Time	NEWCOURTLAND LIFE PROGRAM	NewCourtland LIFE Program	www.newcourtlandlife.org	NewCourland LIFE - Medicare Only (PACE)	08	20		1			H9830	002	0	2019	NewCourtland LIFE - North, NW, NE Phila Svc Area		2		2			2						http://www.medicineshoppe.com/FranchiseeLocations/1024/SpecialServices.aspx	N/A										(888)530-4913		(267)335-1500		(888)530-4913		(267)335-1500										(888)530-4913		(267)335-1500		(888)530-4913		(267)335-1500																
H9834	001	0	1	01	01	H9834_001_0	3	1				07/18/2018	2019.01	07/18/2018 02:03:01 PM Central Daylight Time	06/02/2018 12:02:58 PM Central Daylight Time	06/02/2018 12:01:39 PM Central Daylight Time			07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H9834	001	0	2019	Counties: Fillmore, Houston, Winona		2	1383	2			2						https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H9834	003	0	1	01	01	H9834_003_0	3	1				07/18/2018	2019.01	07/18/2018 02:03:14 PM Central Daylight Time	06/02/2018 12:02:57 PM Central Daylight Time	06/02/2018 12:01:51 PM Central Daylight Time			07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (w/Rx) (HMO)	01	01		1			H9834	003	0	2019	Counties: Fillmore, Houston, Winona		2	8535	2			2						https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H9834	004	0	1	01	01	H9834_004_0	3	1				07/18/2018	2019.01	07/18/2018 02:03:25 PM Central Daylight Time	06/02/2018 12:02:56 PM Central Daylight Time				07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (no Rx) (HMO)	01	01		1			H9834	004	0	2019	Counties: Fillmore, Houston, Winona		2	960	2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H9834	005	0	1	01	01	H9834_005_0	3	1				07/18/2018	2019.01	07/18/2018 02:03:37 PM Central Daylight Time	06/02/2018 12:02:55 PM Central Daylight Time				07/18/2018 02:06:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (no Rx) (HMO)	01	01		1			H9834	005	0	2019	Counties: Fillmore, Houston, Winona		2	60	2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H9842	001	0	1	20	08	H9842_001_0	1	1				05/24/2018	2019.01	05/24/2018 11:22:39 AM Eastern Daylight Time		05/24/2018 10:15:56 AM Eastern Daylight Time			05/24/2018 11:25:49 AM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	sjmed.com\PACE	Saint Joseph PACE (PACE)	08	20		1			H9842	001	0	2019	Partial Saint Joseph, Marshall & Elkhart counties		2		2			2						TBD	TBD												(574)247-8700				(574)247-8700												(574)247-8701				(574)247-8701																
H9842	002	0	1	20	08	H9842_002_0	1	1				05/24/2018	2019.01	05/24/2018 11:23:21 AM Eastern Daylight Time		05/24/2018 10:13:53 AM Eastern Daylight Time			05/24/2018 11:25:49 AM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	sjmed.com\PACE	Saint Joseph PACE - Medicare Only (PACE)	08	20		1			H9842	002	0	2019	Partial St. Joseph, Marshall & Elkhart Counties		2		2			2						TBD	TBD												(574)247-8700				(574)247-8700												(574)247-8701				(574)247-8701																
H9869	001	0	1	48	05	H9869_001_0	7	1				08/24/2018	2019.01	08/24/2018 10:07:40 AM Central Daylight Time					08/24/2018 03:45:59 PM Central Daylight Time	PARTNERS HEALTH PLAN, INC.	Partners Health Plan	www.phpcares.org	PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)	05	48		1			H9869	001	0	2019	Counties: Ki, Qu, Brx, NY, Ri, Wes, Suf, Na, Rck		2		2			2						www.phpcares.org	www.phpcares.org	www.phpcares.org	(855)747-5483		(855)747-5483		(855)747-5483		(855)747-5483		(855)508-1718		(855)508-1718		(855)508-1718		(855)508-1718		(800)662-1220		(711)-		(800)662-1220		(711)-		(800)662-1220		(711)-		(800)662-1220		(711)-																
H9870	001	0	1	01	01	H9870_001_0	17	1	2	1		07/05/2018	2019.01	07/05/2018 09:29:54 AM Eastern Daylight Time	08/03/2018 09:20:42 AM Eastern Daylight Time	08/03/2018 09:20:51 AM Eastern Daylight Time			08/03/2018 11:21:57 AM Eastern Daylight Time	UNIVERSITY HEALTH CARE, INC.	Passport Advantage	www.passportadvantage.com	Passport Advantage (HMO SNP)	01	01		1			H9870	001	0	2019	Jefferson, Hardin, Bullitt and Nelson Counties		2		2			1	3		1		1	www.passportadvantage.com	www.passportadvantage.com	www.passportadvantage.com	(844)859-6152		(844)859-6152		(844)643-2780		(844)643-2780		(844)859-6152		(844)859-6152		(844)643-2780		(844)643-2780		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9877	001	0	1	01	01	H9877_001_0	5	1	2	1		08/06/2018	2019.01	08/06/2018 08:51:56 AM Eastern Daylight Time	08/06/2018 08:43:17 AM Eastern Daylight Time	08/06/2018 08:43:17 AM Eastern Daylight Time			08/06/2018 08:52:30 AM Eastern Daylight Time	VIRGINIA PREMIER HEALTH PLAN, INC.	Virginia Premier	www.virginiapremier.com	Virginia Premier Advantage Elite (HMO SNP)	01	01		1			H9877	001	0	2019	Central, Tidewater, Western, Roanoke, NOVA		2		2			1	3		1		1	www.virginiapremier.com	www.virginiapremier.com	www.virginiapremier.com	(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9877	002	0	1	01	01	H9877_002_0	6	1				08/06/2018	2019.01	08/06/2018 08:54:46 AM Eastern Daylight Time	08/06/2018 08:43:18 AM Eastern Daylight Time	08/06/2018 08:43:18 AM Eastern Daylight Time			08/06/2018 08:55:36 AM Eastern Daylight Time	VIRGINIA PREMIER HEALTH PLAN, INC.	Virginia Premier	www.virginiapremier.com	Virginia Premier Advantage Gold (HMO)	01	01		1			H9877	002	0	2019	Central Virginia and Tidewater		2		2			2						www.virginiapremier.com	www.virginiapremier.com	www.virginiapremier.com	(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9877	003	0	1	01	01	H9877_003_0	6	1				08/06/2018	2019.01	08/06/2018 08:57:16 AM Eastern Daylight Time	08/06/2018 08:43:18 AM Eastern Daylight Time	08/06/2018 08:43:18 AM Eastern Daylight Time			08/06/2018 08:57:53 AM Eastern Daylight Time	VIRGINIA PREMIER HEALTH PLAN, INC.	Virginia Premier	www.virginiapremier.com	Virginia Premier Advantage Platinum (HMO)	01	01		1			H9877	003	0	2019	Central Virginia and Tidewater		2		2			2						www.virginiapremier.com	www.virginiapremier.com	www.virginiapremier.com	(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9878	001	0	1	04	01	H9878_001_0	11	1				07/06/2018	2019.01	07/06/2018 08:34:01 PM Central Daylight Time	08/02/2018 01:43:04 PM Central Daylight Time	08/02/2018 11:18:52 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Flex (PPO)	01	04		1			H9878	001	0	2019	Cincinnati, Toledo, and Youngstown Metro Areas		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9878	002	0	1	04	01	H9878_002_0	11	1				07/06/2018	2019.01	07/06/2018 08:36:21 PM Central Daylight Time	08/02/2018 01:44:04 PM Central Daylight Time	08/02/2018 11:19:38 AM Central Daylight Time			08/06/2018 11:26:59 AM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC.	Bright Health	https://brighthealthplan.com/medicare	Bright Advantage Flex Plus (PPO)	01	04		1			H9878	002	0	2019	Cincinnati, Toledo, and Youngstown Metro Areas		2		2			2						https://brighthealthplan.com/medicare/provider-finder/	https://brighthealthplan.com/medicare/coverage/drugs/search/	https://brighthealthplan.com/medicare/provider-finder/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9952	001	0	1	01	01	H9952_001_0	4	1	2	1		08/07/2018	2019.01	08/07/2018 12:34:51 PM Central Daylight Time	08/09/2018 12:04:22 PM Central Daylight Time	08/06/2018 03:09:11 PM Central Daylight Time			08/09/2018 01:17:08 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	medica.com	Medica AccessAbility Solution Enhanced (HMO SNP)	01	01		1			H9952	001	0	2019	Minneapolis/St. Paul Metro Area		2	8192	2			1	3		1		1	medica.com/Members	medica.com/Members	medica.com/Members	(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9998	001	0	1	20	08	H9998_001_0	1	1				05/23/2018	2019.01	05/23/2018 12:09:38 PM Central Daylight Time		05/23/2018 11:45:37 AM Central Daylight Time			05/23/2018 12:15:39 PM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstarlubbock.org	Silver Star - Dual (PACE)	08	20		1			H9998	001	0	2019	Lubbock County		2		2			2						http://www.seniorscript.com/	www.silverstarlubbock.org										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500																
H9998	002	0	1	20	08	H9998_002_0	1	1				05/23/2018	2019.01	05/23/2018 12:11:24 PM Central Daylight Time		05/23/2018 11:45:29 AM Central Daylight Time			05/23/2018 12:15:39 PM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstarlubbock.org	Silver Star - Medicare only (PACE)	08	20		1			H9998	002	0	2019	Lubbock County		2		2			2						http://www.seniorscript.com/	www.silverstarlubbock.org										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500																
R0110	001	0	1	31	11	R0110_001_0	5	1				07/12/2018	2019.01	07/12/2018 09:46:23 AM Eastern Daylight Time	08/03/2018 12:35:27 PM Eastern Daylight Time				08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-001 (Regional PPO)	11	31		1			R0110	001	0	2019	States of Louisiana and Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0110	002	0	1	31	11	R0110_002_0	4	1				07/02/2018	2019.01	07/02/2018 11:47:38 AM Eastern Daylight Time	08/03/2018 12:37:46 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-002 (Regional PPO)	11	31		1			R0110	002	0	2019	States of Louisiana and Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0110	003	0	1	31	11	R0110_003_0	5	1				07/11/2018	2019.01	07/11/2018 09:23:01 PM Eastern Daylight Time	08/03/2018 12:33:34 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-003 (Regional PPO)	11	31		1			R0110	003	0	2019	States of Louisiana and Mississippi		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0110	801	0	1	31	11	R0110_801_0	2	1				05/31/2018	2019.01	05/31/2018 12:19:02 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	801	0	2019	States of Louisiana and Mississippi		1	2036	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0110	802	0	1	31	11	R0110_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:20:23 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	802	0	2019	States of Louisiana and Mississippi		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0110	803	0	1	31	11	R0110_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:22:56 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R0110	803	0	2019	States of Louisiana and Mississippi		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0802	001	0	1	31	11	R0802_001_0	7	1				08/02/2018	2019.01	08/02/2018 10:00:43 AM Eastern Daylight Time	08/07/2018 12:44:15 PM Eastern Daylight Time	08/07/2018 12:44:24 PM Eastern Daylight Time			08/07/2018 06:48:47 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Flex (Regional PPO)	11	31		1			R0802	001	0	2019	Northern New England (New Hampshire and Maine)		2		2			2						www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0865	001	0	1	31	11	R0865_001_0	4	1				08/01/2018	2019.01	08/01/2018 04:27:04 PM Eastern Daylight Time	08/03/2018 03:22:19 PM Eastern Daylight Time				08/06/2018 10:52:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-001 (Regional PPO)	11	31		1			R0865	001	0	2019	States of Indiana and Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0865	003	0	1	31	11	R0865_003_0	3	1				08/01/2018	2019.01	08/01/2018 03:10:57 PM Eastern Daylight Time	08/03/2018 03:37:54 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:52:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-003 (Regional PPO)	11	31		1			R0865	003	0	2019	States of Indiana and Kentucky		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0865	801	0	1	31	11	R0865_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:25:23 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	801	0	2019	States of Indiana and Kentucky		1	8630	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0865	802	0	1	31	11	R0865_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:26:56 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	802	0	2019	States of Indiana and Kentucky		1	2496	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0865	803	0	1	31	11	R0865_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:27:56 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R0865	803	0	2019	States of Indiana and Kentucky		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0923	001	0	1	31	11	R0923_001_0	4	1				07/16/2018	2019.01	07/16/2018 10:00:13 AM Eastern Daylight Time	08/03/2018 03:20:04 PM Eastern Daylight Time				08/06/2018 10:52:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-001 (Regional PPO)	11	31		1			R0923	001	0	2019	States of Pennsylvania and West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0923	002	0	1	31	11	R0923_002_0	4	1				07/05/2018	2019.01	07/05/2018 01:58:14 PM Eastern Daylight Time	08/03/2018 03:35:43 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:52:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-002 (Regional PPO)	11	31		1			R0923	002	0	2019	States of Pennsylvania and West Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0923	801	0	1	31	11	R0923_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:29:12 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	801	0	2019	States of Pennsylvania and West Verginia		1	1925	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0923	802	0	1	31	11	R0923_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:30:02 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	802	0	2019	States of Pennsylvania and West Verginia		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0923	803	0	1	31	11	R0923_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:30:27 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R0923	803	0	2019	States of Pennsylvania and West Verginia		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1390	001	0	1	31	11	R1390_001_0	5	1				08/02/2018	2019.01	08/02/2018 11:07:24 AM Eastern Daylight Time	08/03/2018 09:52:48 AM Eastern Daylight Time				08/06/2018 10:54:54 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-001 (Regional PPO)	11	31		1			R1390	001	0	2019	States of North Carolina and Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R1390	002	0	1	31	11	R1390_002_0	6	1				07/16/2018	2019.01	07/16/2018 02:43:15 PM Eastern Daylight Time	08/03/2018 09:53:20 AM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:54:54 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-002 (Regional PPO)	11	31		1			R1390	002	0	2019	States of North Carolina and Virginia		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R1390	801	0	1	31	11	R1390_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:31:36 PM Eastern Daylight Time					05/31/2018 01:27:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	801	0	2019	States of North Carolina and Virginia		1	2310	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1390	802	0	1	31	11	R1390_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:35:41 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	802	0	2019	States of North Carolina and Virginia		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1390	803	0	1	31	11	R1390_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:36:50 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R1390	803	0	2019	States of North Carolina and Virginia		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1532	001	0	1	31	11	R1532_001_0	3	1				07/02/2018	2019.01	07/02/2018 02:33:18 PM Eastern Daylight Time	08/03/2018 05:55:15 PM Eastern Daylight Time				08/06/2018 10:35:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-001 (Regional PPO)	11	31		1			R1532	001	0	2019	States of Arkansas and Missouri		2		2			2						www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R1532	002	0	1	31	11	R1532_002_0	4	1				07/03/2018	2019.01	07/03/2018 03:52:05 PM Eastern Daylight Time	08/03/2018 05:49:20 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:35:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-002 (Regional PPO)	11	31		1			R1532	002	0	2019	States of Arkansas and Missouri		2		2			2						www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R1532	801	0	1	31	11	R1532_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:38:53 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	801	0	2019	States of Arkansas and Missouri		1	1664	2			2						www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1532	802	0	1	31	11	R1532_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:39:36 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	802	0	2019	States of Arkansas and Missouri		1	1200	2			2						www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1532	803	0	1	31	11	R1532_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:43:45 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R1532	803	0	2019	States of Arkansas and Missouri		1	1200	2			2						www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1548	001	0	1	31	11	R1548_001_0	3	1	2	1		08/06/2018	2019.01	08/06/2018 09:22:23 AM Central Daylight Time	08/03/2018 10:18:25 AM Central Daylight Time	07/31/2018 08:06:44 PM Central Daylight Time			08/06/2018 10:36:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO SNP)	11	31		1			R1548	001	0	2019	North Carolina and Virginia		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3175	003	0	1	31	11	R3175_003_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:19:12 PM Central Daylight Time	08/03/2018 10:25:06 AM Central Daylight Time	07/31/2018 08:07:12 PM Central Daylight Time			08/06/2018 10:36:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO SNP)	11	31		1			R3175	003	0	2019	State of Hawaii		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3175	801	0	1	31	11	R3175_801_0	1	1				06/02/2018	2019.01	06/02/2018 12:52:14 PM Central Daylight Time					06/02/2018 12:52:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	801	0	2019	State of Hawaii		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
R3175	802	0	1	31	11	R3175_802_0	1	1				05/25/2018	2019.01	05/25/2018 01:12:50 PM Central Daylight Time					06/02/2018 12:52:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	802	0	2019	State of Hawaii		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3332	001	0	1	31	11	R3332_001_0	8	1				07/03/2018	2019.01	07/03/2018 10:22:51 AM Eastern Daylight Time	08/06/2018 02:06:22 PM Eastern Daylight Time	07/31/2018 07:44:06 PM Eastern Daylight Time			08/07/2018 02:35:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Choice (Regional PPO)	11	31		1			R3332	001	0	2019	State of Florida		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2						2			
R3392	001	0	1	31	11	R3392_001_0	5	1				08/03/2018	2019.01	08/03/2018 03:14:13 PM Eastern Daylight Time	08/03/2018 01:31:11 PM Eastern Daylight Time				08/06/2018 10:21:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-001 (Regional PPO)	11	31		1			R3392	001	0	2019	States of Georgia and South Carolina		2		2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R3392	002	0	1	31	11	R3392_002_0	4	1				07/12/2018	2019.01	07/12/2018 10:35:11 AM Eastern Daylight Time	08/03/2018 01:32:54 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:21:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-002 (Regional PPO)	11	31		1			R3392	002	0	2019	States of Georgia and South Carolina		2		2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3392	801	0	1	31	11	R3392_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:45:25 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	801	0	2019	States of Georgia and South Carolina		1	3973	2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3392	802	0	1	31	11	R3392_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:46:41 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	802	0	2019	States of Georgia and South Carolina		1	1200	2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3392	803	0	1	31	11	R3392_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:47:33 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R3392	803	0	2019	States of Georgia and South Carolina		1	1200	2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3444	008	0	1	31	11	R3444_008_0	2	1		1		08/02/2018	2019.01	08/02/2018 01:14:03 PM Central Daylight Time	08/03/2018 10:11:26 AM Central Daylight Time	07/31/2018 08:07:38 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO SNP)	11	31		1			R3444	008	0	2019	Arkansas and Missouri		2		2			1	4			00000000000000000100		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	009	0	1	31	11	R3444_009_0	3	1		1		08/02/2018	2019.01	08/02/2018 01:15:24 PM Central Daylight Time	08/03/2018 10:12:04 AM Central Daylight Time	07/31/2018 08:08:02 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO SNP)	11	31		1			R3444	009	0	2019	Arkansas and Missouri		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	011	0	1	31	11	R3444_011_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:20:15 PM Central Daylight Time	08/03/2018 10:12:41 AM Central Daylight Time	07/31/2018 08:08:30 PM Central Daylight Time			08/06/2018 10:36:55 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (Regional PPO SNP)	11	31		1			R3444	011	0	2019	Arkansas and Missouri		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	012	0	1	31	11	R3444_012_0	3	1				08/03/2018	2019.01	08/03/2018 03:10:40 PM Central Daylight Time	08/03/2018 10:13:20 AM Central Daylight Time	07/31/2018 08:08:54 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (Regional PPO)	11	31		1			R3444	012	0	2019	Arkansas and Missouri		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3887	001	0	1	31	11	R3887_001_0	4	1				07/06/2018	2019.01	07/06/2018 03:25:33 PM Eastern Daylight Time	08/03/2018 01:35:09 PM Eastern Daylight Time				08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-001 (Regional PPO)	11	31		1			R3887	001	0	2019	State of Michigan		2		2			2						http://www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R3887	002	0	1	31	11	R3887_002_0	6	1				07/18/2018	2019.01	07/18/2018 03:38:47 PM Eastern Daylight Time	08/03/2018 01:42:01 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-002 (Regional PPO)	11	31		1			R3887	002	0	2019	State of Michigan		2		2			2						http://www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3887	801	0	1	31	11	R3887_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:48:56 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	801	0	2019	State of Michigan		1	6817	2			2						http://www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3887	802	0	1	31	11	R3887_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:49:59 PM Eastern Daylight Time					05/31/2018 01:49:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	802	0	2019	State of Michigan		1	7040	2			2						http://www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3887	803	0	1	31	11	R3887_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:50:55 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R3887	803	0	2019	State of Michigan		1	1200	2			2						http://www.humana.com/medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4182	001	0	1	31	11	R4182_001_0	4	1				08/02/2018	2019.01	08/02/2018 03:02:08 PM Eastern Daylight Time	08/03/2018 02:56:57 PM Eastern Daylight Time				08/06/2018 01:06:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-001 (Regional PPO)	11	31		1			R4182	001	0	2019	State of Texas		2		2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R4182	003	0	1	31	11	R4182_003_0	4	1				08/02/2018	2019.01	08/02/2018 09:13:52 AM Eastern Daylight Time	08/03/2018 02:51:03 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-003 (Regional PPO)	11	31		1			R4182	003	0	2019	State of Texas		2		2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4182	004	0	1	31	11	R4182_004_0	4	1				07/11/2018	2019.01	07/11/2018 08:27:39 AM Eastern Daylight Time	08/03/2018 03:02:54 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 01:06:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-004 (Regional PPO)	11	31		1			R4182	004	0	2019	State of Texas		2		2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4182	801	0	1	31	11	R4182_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:52:33 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	801	0	2019	State of Texas		1	3737	2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4182	802	0	1	31	11	R4182_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:53:51 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	802	0	2019	State of Texas		1	1200	2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4182	803	0	1	31	11	R4182_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:54:47 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R4182	803	0	2019	State of Texas		1	1200	2			2						http:www.humana.com/medicare/medicare_prescription_drugs/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4487	001	0	1	31	11	R4487_001_0	9	1				06/04/2018	2019.01	06/04/2018 09:55:11 AM Eastern Daylight Time	08/06/2018 02:10:49 AM Eastern Daylight Time	08/01/2018 08:47:27 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com	Anthem MediBlue Access Basic (Regional PPO)	11	31		1			R4487	001	0	2019	Indiana and Kentucky		2	528300	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4845	001	0	1	31	11	R4845_001_0	3	1				07/02/2018	2019.01	07/02/2018 04:09:09 PM Eastern Daylight Time	08/03/2018 05:59:47 PM Eastern Daylight Time				08/06/2018 10:19:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-001 (Regional PPO)	11	31		1			R4845	001	0	2019	States of Kansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R4845	002	0	1	31	11	R4845_002_0	3	1				07/02/2018	2019.01	07/02/2018 04:09:25 PM Eastern Daylight Time	08/03/2018 05:52:12 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:12:47 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-002 (Regional PPO)	11	31		1			R4845	002	0	2019	States of Kansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4845	801	0	1	31	11	R4845_801_0	1	1				05/31/2018	2019.01	05/31/2018 12:56:24 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	801	0	2019	States of Kansas and Oklahoma		1	1200	2			2						https://www.humana.com/pharmacy/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4845	802	0	1	31	11	R4845_802_0	1	1				05/31/2018	2019.01	05/31/2018 12:58:08 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	802	0	2019	States of Kansas and Oklahoma		1	1200	2			2						https://www.humana.com/pharmacy/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4845	803	0	1	31	11	R4845_803_0	1	1				05/31/2018	2019.01	05/31/2018 12:58:56 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R4845	803	0	2019	States of Kansas and Oklahoma		1	1200	2			2						https://www.humana.com/pharmacy/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5329	001	0	1	31	11	R5329_001_0	4	1				07/12/2018	2019.01	07/12/2018 01:12:47 PM Central Daylight Time	08/03/2018 10:56:40 AM Central Daylight Time	07/31/2018 08:09:20 PM Central Daylight Time			08/06/2018 02:38:06 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (Regional PPO)	11	31		1			R5329	001	0	2019	Rural ME and NH		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5342	001	0	1	31	11	R5342_001_0	4	1				07/12/2018	2019.01	07/12/2018 01:13:25 PM Central Daylight Time	08/03/2018 10:30:24 AM Central Daylight Time	07/31/2018 08:09:44 PM Central Daylight Time			08/06/2018 02:38:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)	11	31		1			R5342	001	0	2019	State of New York		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5342	002	0	1	31	11	R5342_002_0	4	1				07/19/2018	2019.01	07/19/2018 01:36:02 PM Central Daylight Time	08/03/2018 10:31:02 AM Central Daylight Time				08/06/2018 03:08:50 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)	11	31		1			R5342	002	0	2019	State of New York		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5342	005	0	1	31	11	R5342_005_0	4	1				07/19/2018	2019.01	07/19/2018 10:21:05 AM Central Daylight Time	08/03/2018 10:31:38 AM Central Daylight Time	07/31/2018 08:10:20 PM Central Daylight Time			08/06/2018 02:38:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)	11	31		1			R5342	005	0	2019	State of New York		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5342	006	0	1	31	11	R5342_006_0	4	1				07/12/2018	2019.01	07/12/2018 04:24:45 PM Central Daylight Time	08/03/2018 10:32:15 AM Central Daylight Time	07/31/2018 08:10:46 PM Central Daylight Time			08/06/2018 02:38:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)	11	31		1			R5342	006	0	2019	State of New York		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5342	801	0	1	31	11	R5342_801_0	1	1				05/25/2018	2019.01	05/25/2018 04:38:52 PM Central Daylight Time					06/02/2018 12:55:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	801	0	2019	State of New York		1	2628	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
R5342	802	0	1	31	11	R5342_802_0	1	1				05/25/2018	2019.01	05/25/2018 04:41:09 PM Central Daylight Time					06/02/2018 12:55:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	802	0	2019	State of New York		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
R5342	803	0	1	31	11	R5342_803_0	1	1				05/25/2018	2019.01	05/25/2018 04:43:16 PM Central Daylight Time					06/02/2018 12:55:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	803	0	2019	New York		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
R5361	001	0	1	31	11	R5361_001_0	5	1				07/05/2018	2019.01	07/05/2018 05:30:14 PM Eastern Daylight Time	08/03/2018 06:31:58 PM Eastern Daylight Time				08/06/2018 10:39:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5361-001 (Regional PPO)	11	31		1			R5361	001	0	2019	States of Illinois and Wisconsin		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5361	002	0	1	31	11	R5361_002_0	5	1				07/05/2018	2019.01	07/05/2018 05:36:57 PM Eastern Daylight Time	08/03/2018 06:34:19 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:39:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5361-002 (Regional PPO)	11	31		1			R5361	002	0	2019	States of Illinois and Wisconsin		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5361	801	0	1	31	11	R5361_801_0	1	1				05/31/2018	2019.01	05/31/2018 01:01:10 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	801	0	2019	States of Illinois and Wisconsin		1	11125	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5361	802	0	1	31	11	R5361_802_0	1	1				05/31/2018	2019.01	05/31/2018 01:02:11 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	802	0	2019	States of Illnois and Wisconsin		1	7264	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5361	803	0	1	31	11	R5361_803_0	1	1				05/31/2018	2019.01	05/31/2018 01:03:10 PM Eastern Daylight Time					05/31/2018 02:05:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5361	803	0	2019	States of Illnois and Wisconsin		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5495	001	0	1	31	11	R5495_001_0	5	1				08/02/2018	2019.01	08/02/2018 09:49:26 AM Eastern Daylight Time	08/03/2018 01:34:30 PM Eastern Daylight Time				08/06/2018 10:50:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-001 (Regional PPO)	11	31		1			R5495	001	0	2019	State of Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5495	002	0	1	31	11	R5495_002_0	3	1				07/05/2018	2019.01	07/05/2018 02:08:49 PM Eastern Daylight Time	08/03/2018 01:42:34 PM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 10:28:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-002 (Regional PPO)	11	31		1			R5495	002	0	2019	State of Ohio		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5495	801	0	1	31	11	R5495_801_0	1	1				05/31/2018	2019.01	05/31/2018 01:04:36 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	801	0	2019	State of Ohio		1	4234	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5495	802	0	1	31	11	R5495_802_0	1	1				05/31/2018	2019.01	05/31/2018 01:08:53 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	802	0	2019	State of Ohio		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5495	803	0	1	31	11	R5495_803_0	1	1				05/31/2018	2019.01	05/31/2018 01:10:14 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5495	803	0	2019	State of Ohio		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5826	005	0	1	31	11	R5826_005_0	5	1				07/12/2018	2019.01	07/12/2018 11:05:18 AM Eastern Daylight Time	08/03/2018 11:53:37 AM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-005 (Regional PPO)	11	31		1			R5826	005	0	2019	State of Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	018	0	1	31	11	R5826_018_0	5	1				08/01/2018	2019.01	08/01/2018 03:20:02 PM Eastern Daylight Time	08/03/2018 11:47:12 AM Eastern Daylight Time				08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-018 (Regional PPO)	11	31		1			R5826	018	0	2019	State of Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	074	0	1	31	11	R5826_074_0	6	1				08/01/2018	2019.01	08/01/2018 03:29:25 PM Eastern Daylight Time	08/03/2018 11:47:41 AM Eastern Daylight Time	08/03/2018 09:21:25 AM Eastern Daylight Time			08/06/2018 09:55:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-074 (Regional PPO)	11	31		1			R5826	074	0	2019	State of Florida		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	805	0	1	31	11	R5826_805_0	1	1				05/31/2018	2019.01	05/31/2018 01:13:20 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	805	0	2019	State of Florida		1	10207	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5826	819	0	1	31	11	R5826_819_0	1	1				05/31/2018	2019.01	05/31/2018 01:13:45 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	819	0	2019	State of Florida		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5826	834	0	1	31	11	R5826_834_0	1	1				05/31/2018	2019.01	05/31/2018 01:14:18 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	834	0	2019	State of Florida		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5941	013	0	1	31	11	R5941_013_0	8	1				06/04/2018	2019.01	06/04/2018 09:55:19 AM Eastern Daylight Time	08/06/2018 02:11:51 AM Eastern Daylight Time				08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Core (Regional PPO)	11	31		1			R5941	013	0	2019	Ohio		2	25872	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5941	014	0	1	31	11	R5941_014_0	8	1				06/04/2018	2019.01	06/04/2018 09:55:30 AM Eastern Daylight Time	08/06/2018 02:12:52 AM Eastern Daylight Time	08/01/2018 08:48:10 PM Eastern Daylight Time			08/06/2018 06:09:23 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Basic (Regional PPO)	11	31		1			R5941	014	0	2019	Ohio		2	298872	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560		(800)467-1199		(800)467-1199		(844)364-2126		(844)364-2126		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	003	0	1	31	11	R6694_003_0	6	1				07/11/2018	2019.01	07/11/2018 11:11:00 AM Eastern Daylight Time	08/02/2018 03:10:15 PM Eastern Daylight Time	08/01/2018 12:10:06 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare OH Connect Gold (Regional PPO)	11	31		1			R6694	003	0	2019	Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	005	0	1	31	11	R6694_005_0	3	1				07/11/2018	2019.01	07/11/2018 11:11:35 AM Eastern Daylight Time	08/02/2018 03:10:54 PM Eastern Daylight Time	08/01/2018 12:11:00 AM Eastern Daylight Time			08/05/2018 08:46:04 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare OH Connect Gold 2 (Regional PPO)	11	31		1			R6694	005	0	2019	Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	006	0	1	31	11	R6694_006_0	4	1				07/11/2018	2019.01	07/11/2018 09:28:43 AM Central Daylight Time	08/03/2018 07:56:48 AM Central Daylight Time	07/31/2018 10:40:22 PM Central Daylight Time			08/05/2018 06:34:27 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare NJ Silver Plan (Regional PPO)	11	31		1			R6694	006	0	2019	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	008	0	1	31	11	R6801_008_0	2	1		1		08/02/2018	2019.01	08/02/2018 02:44:02 PM Central Daylight Time	08/03/2018 10:32:50 AM Central Daylight Time	07/31/2018 08:11:10 PM Central Daylight Time			08/06/2018 09:55:57 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO SNP)	11	31		1			R6801	008	0	2019	Texas		2		2			1	4			00000000000000000100		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	009	0	1	31	11	R6801_009_0	3	1		1		08/02/2018	2019.01	08/02/2018 02:15:59 PM Central Daylight Time	08/03/2018 10:33:32 AM Central Daylight Time	07/31/2018 08:11:34 PM Central Daylight Time			08/06/2018 09:55:57 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO SNP)	11	31		1			R6801	009	0	2019	Texas		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	011	0	1	31	11	R6801_011_0	2	1	2	1		08/02/2018	2019.01	08/02/2018 01:21:15 PM Central Daylight Time	08/03/2018 10:34:13 AM Central Daylight Time	07/31/2018 08:12:00 PM Central Daylight Time			08/06/2018 10:36:55 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (Regional PPO SNP)	11	31		1			R6801	011	0	2019	Texas		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	012	0	1	31	11	R6801_012_0	3	1				08/03/2018	2019.01	08/03/2018 09:15:37 AM Central Daylight Time	08/03/2018 10:34:55 AM Central Daylight Time	07/31/2018 08:12:26 PM Central Daylight Time			08/06/2018 09:55:57 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (Regional PPO)	11	31		1			R6801	012	0	2019	Texas		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7220	001	0	1	31	11	R7220_001_0	5	1				07/11/2018	2019.01	07/11/2018 01:38:06 PM Eastern Daylight Time	08/03/2018 01:36:10 PM Eastern Daylight Time				08/06/2018 12:39:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-001 (Regional PPO)	11	31		1			R7220	001	0	2019	State of Arizona		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R7220	002	0	1	31	11	R7220_002_0	5	1				07/02/2018	2019.01	07/02/2018 04:58:28 PM Eastern Daylight Time	08/03/2018 01:37:07 PM Eastern Daylight Time	08/03/2018 09:21:26 AM Eastern Daylight Time			08/06/2018 12:39:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-002 (Regional PPO)	11	31		1			R7220	002	0	2019	State of Arizona		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7220	801	0	1	31	11	R7220_801_0	1	1				05/31/2018	2019.01	05/31/2018 01:15:28 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	801	0	2019	State of Arizona		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7220	802	0	1	31	11	R7220_802_0	1	1				05/31/2018	2019.01	05/31/2018 01:15:55 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	802	0	2019	State of Arizona		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7220	803	0	1	31	11	R7220_803_0	1	1				05/31/2018	2019.01	05/31/2018 01:19:02 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R7220	803	0	2019	State of Arizona		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7315	001	0	1	31	11	R7315_001_0	4	1				07/02/2018	2019.01	07/02/2018 03:41:06 PM Eastern Daylight Time	08/03/2018 12:18:18 PM Eastern Daylight Time				08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7315-001 (Regional PPO)	11	31		1			R7315	001	0	2019	States of Alabama and Tennessee		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R7315	002	0	1	31	11	R7315_002_0	4	1				07/02/2018	2019.01	07/02/2018 03:41:48 PM Eastern Daylight Time	08/03/2018 12:21:29 PM Eastern Daylight Time	08/03/2018 09:21:26 AM Eastern Daylight Time			08/06/2018 10:11:53 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7315-002 (Regional PPO)	11	31		1			R7315	002	0	2019	States of Alabama and Tennessee		2		2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7315	801	0	1	31	11	R7315_801_0	1	1				05/31/2018	2019.01	05/31/2018 01:20:55 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	801	0	2019	States of Alabama and Tennessee		1	3005	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7315	802	0	1	31	11	R7315_802_0	1	1				05/31/2018	2019.01	05/31/2018 01:24:12 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	802	0	2019	States of Alabama and Tennessee		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7315	803	0	1	31	11	R7315_803_0	1	1				05/31/2018	2019.01	05/31/2018 01:22:57 PM Eastern Daylight Time					05/31/2018 02:10:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R7315	803	0	2019	States of Alabama and Tennessee		1	1200	2			2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7444	001	0	1	31	11	R7444_001_0	5	1				07/17/2018	2019.01	07/17/2018 11:29:40 AM Central Daylight Time	08/03/2018 10:32:14 AM Central Daylight Time	07/31/2018 08:12:50 PM Central Daylight Time			08/06/2018 09:43:25 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (Regional PPO)	11	31		1			R7444	001	0	2019	New England		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	003	0	1	31	11	R7444_003_0	3	1				08/02/2018	2019.01	08/02/2018 04:17:58 PM Central Daylight Time	08/03/2018 10:32:46 AM Central Daylight Time	07/31/2018 08:13:14 PM Central Daylight Time			08/06/2018 10:35:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (Regional PPO)	11	31		1			R7444	003	0	2019	State of Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	004	0	1	31	11	R7444_004_0	3	1				08/02/2018	2019.01	08/02/2018 04:22:04 PM Central Daylight Time	08/03/2018 10:33:20 AM Central Daylight Time				08/06/2018 10:35:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Essential (Regional PPO)	11	31		1			R7444	004	0	2019	State of Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
R7444	008	0	1	31	11	R7444_008_0	3	1				08/02/2018	2019.01	08/02/2018 01:19:11 PM Central Daylight Time	08/03/2018 10:33:53 AM Central Daylight Time	07/31/2018 08:13:38 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (Regional PPO)	11	31		1			R7444	008	0	2019	Georgia and South Carolina		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	009	0	1	31	11	R7444_009_0	2	1		1		08/02/2018	2019.01	08/02/2018 01:20:00 PM Central Daylight Time	08/03/2018 10:34:27 AM Central Daylight Time	07/31/2018 08:14:04 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO SNP)	11	31		1			R7444	009	0	2019	Georgia and South Carolina		2		2			1	4			00000000000000000100		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	010	0	1	31	11	R7444_010_0	3	1		1		08/02/2018	2019.01	08/02/2018 01:21:07 PM Central Daylight Time	08/03/2018 10:35:00 AM Central Daylight Time	07/31/2018 08:14:28 PM Central Daylight Time			08/06/2018 08:36:41 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO SNP)	11	31		1			R7444	010	0	2019	Georgia and South Carolina		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	011	0	1	31	11	R7444_011_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 01:22:29 PM Central Daylight Time	08/03/2018 10:35:34 AM Central Daylight Time	07/31/2018 08:14:56 PM Central Daylight Time			08/06/2018 10:36:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (Regional PPO SNP)	11	31		1			R7444	011	0	2019	Georgia and South Carolina		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	012	0	1	31	11	R7444_012_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 01:23:33 PM Central Daylight Time	08/03/2018 10:36:06 AM Central Daylight Time	07/31/2018 08:15:22 PM Central Daylight Time			08/06/2018 10:36:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO SNP)	11	31		1			R7444	012	0	2019	State of Florida		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	013	0	1	31	11	R7444_013_0	3	1	2	1		08/02/2018	2019.01	08/02/2018 01:24:17 PM Central Daylight Time	08/03/2018 10:36:38 AM Central Daylight Time	07/31/2018 08:15:48 PM Central Daylight Time			08/06/2018 10:36:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP ONE (Regional PPO SNP)	11	31		1			R7444	013	0	2019	State of Florida		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
S0586	801	0		29	10	S0586_801_0	1	1				04/12/2018	2019.01	04/12/2018 12:12:45 PM Eastern Daylight Time					06/03/2018 01:14:35 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP Health Care	www.mvphealthcare.com	MVP RxCare - Employer Group (PDP)	10	29					S0586	801	0	2019	United States and Puerto Rico		1					2						https://content.mvphealthcare.com/medicare/PartD	https://content.mvphealthcare.com/medicare/PartD										(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899										(711)-		(711)-		(800)662-1220		(800)662-1220																
S0655	801	0		29	10	S0655_801_0	5	1				05/18/2018	2019.01	05/18/2018 09:46:11 AM Eastern Daylight Time					06/04/2018 03:16:04 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	801	0	2019	Massachusetts and Nationwide		1					2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage										(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-																
S0655	802	0		29	10	S0655_802_0	5	1				04/16/2018	2019.01	04/16/2018 11:07:55 AM Eastern Daylight Time					06/04/2018 03:16:04 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	802	0	2019	Massachusetts and Nationwide		1					2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage										(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-																
S1030	001	0		29	10	S1030_001_0	2	1				06/02/2018	2019.01	06/02/2018 10:50:44 AM Central Daylight Time		06/02/2018 10:05:15 AM Central Daylight Time			06/02/2018 11:30:45 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced Plus (PDP)	10	29					S1030	001	0	2019	State of Alabama, State of Tennessee		2					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	006	0		29	10	S1030_006_0	5	1				08/10/2018	2019.01	08/10/2018 09:18:38 AM Central Daylight Time		08/10/2018 09:11:34 AM Central Daylight Time			08/10/2018 09:18:57 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Essential (PDP)	10	29					S1030	006	0	2019	State of Alabama, State of Tennessee		2					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	010	0		29	10	S1030_010_0	3	1				05/29/2018	2019.01	05/29/2018 02:15:46 PM Central Daylight Time		06/02/2018 10:05:15 AM Central Daylight Time			06/02/2018 11:20:21 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced (PDP)	10	29					S1030	010	0	2019	State of Alabama, State of Tennessee		2					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)327-3988		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	801	0		29	10	S1030_801_0	2	1				05/29/2018	2019.01	05/29/2018 11:27:57 AM Central Daylight Time					06/02/2018 11:21:30 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 801 (PDP)	10	29					S1030	801	0	2019	State of Alabama, State of Tennessee		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	802	0		29	10	S1030_802_0	1	1				05/03/2018	2019.01	05/03/2018 01:32:37 PM Central Daylight Time					06/02/2018 11:32:26 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 802 (PDP)	10	29					S1030	802	0	2019	State of Alabama, State of Tennessee		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	803	0		29	10	S1030_803_0	2	1				05/29/2018	2019.01	05/29/2018 11:28:02 AM Central Daylight Time					06/02/2018 11:21:30 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 803 (PDP)	10	29					S1030	803	0	2019	State of Alabama, State of Tennessee		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	804	0		29	10	S1030_804_0	1	1				04/20/2018	2019.01	04/20/2018 01:50:07 PM Central Daylight Time					06/02/2018 11:32:26 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 804 (PDP)	10	29					S1030	804	0	2019	State of Alabama, State of Tennessee		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1140	801	0		29	10	S1140_801_0	2	1				06/01/2018	2019.01	06/01/2018 11:30:05 AM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	Group PDP (PDP)	10	29					S1140	801	0	2019	New York State		1					2						www.nymedicare.com	www.nymedicare.com	www.nymedicare.com									(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-																
S1140	802	0		29	10	S1140_802_0	2	1				06/01/2018	2019.01	06/01/2018 11:30:14 AM Eastern Daylight Time					06/01/2018 01:33:18 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	Group PDP Enhanced (PDP)	10	29					S1140	802	0	2019	New York State		1					2						www.nymedicare.com	www.nymedicare.com	www.nymedicare.com									(877)461-9218		(877)461-9218		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-																
S1822	801	0		29	10	S1822_801_0	1	1				06/01/2018	2019.01	06/01/2018 11:48:41 AM Central Daylight Time					06/01/2018 01:17:06 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree National Choice CY (PDP)	10	29					S1822	801	0	2019	Nationwide		1					2						healthpartners.com/medicare	healthpartners.com/medicarerx										(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(711)-		(711)-		(711)-		(711)-																
S1822	802	0		29	10	S1822_802_0	1	1				06/01/2018	2019.01	06/01/2018 11:48:50 AM Central Daylight Time					06/01/2018 01:17:06 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree National Choice NCY (PDP)	10	29					S1822	802	0	2019	Nationwide		1					2						healthpartners.com/medicare	healthpartners.com/medicarerx										(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(711)-		(711)-		(711)-		(711)-																
S1894	001	0		29	10	S1894_001_0	5	1				06/03/2018	2019.01	06/03/2018 12:35:54 AM Eastern Daylight Time		06/04/2018 09:45:34 PM Eastern Daylight Time			06/04/2018 09:47:48 PM Eastern Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Scripts	http://www.ccokadvantage.com	CommunityCare Senior Scripts (PDP)	10	29					S1894	001	0	2019	State of Oklahoma		2					2						http://www.ccok.com/directory/Pdirectory.dll/ISzLKXSb40oGkbMfUWw0wa/$/?busunit=10&progno=GP	http://www.ccok.com/rxFormulary/isRxFormulary.dll/M-SoDLvkLKUEikLQR~ArNW/$/?switch=7										(877)293-8628		(918)594-5211		(877)293-8628		(918)594-5211										(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353																
S2468	003	0		29	10	S2468_003_0	1	1				05/22/2018	2019.01	05/22/2018 07:31:06 AM Pacific Daylight Time		05/29/2018 08:44:39 PM Pacific Daylight Time			05/31/2018 02:37:00 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Rx Plus (PDP)	10	29					S2468	003	0	2019	State of California		2					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(888)239-6469		(888)239-6469		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-																
S2468	004	0		29	10	S2468_004_0	2	1				05/22/2018	2019.01	05/22/2018 07:36:09 AM Pacific Daylight Time		05/31/2018 02:29:13 PM Pacific Daylight Time			05/31/2018 02:55:16 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Rx Enhanced (PDP)	10	29					S2468	004	0	2019	State of California		2					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(888)239-6469		(888)239-6469		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-																
S2468	801	0		29	10	S2468_801_0	2	1				05/23/2018	2019.01	05/23/2018 10:33:12 AM Pacific Daylight Time					05/31/2018 02:45:03 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	801	0	2019	PDP Employer Group Plan		1					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2468	802	0		29	10	S2468_802_0	2	1				04/12/2018	2019.01	04/12/2018 02:09:58 PM Pacific Daylight Time					05/31/2018 02:45:03 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	802	0	2019	PDP Employer Group Plan		1					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2668	005	0		29	10	S2668_005_0	18	1				05/24/2018	2019.01	05/24/2018 08:47:57 AM Central Daylight Time		07/27/2018 08:16:39 AM Central Daylight Time			07/27/2018 05:51:03 PM Central Daylight Time	MEMBERS HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	www.fbhealthplans.com/part-d	Farm Bureau Essential Rx (PDP)	10	29					S2668	005	0	2019	Alabama and Tennessee		2					2						fbhealthplans.com placeholder	www.fbhealthplans.com/part-d/essentialrx										(866)643-6924		(866)643-6924		(866)643-6924		(866)643-6924										(711)-		(711)-		(711)-		(711)-																
S2668	006	0		29	10	S2668_006_0	18	1				05/24/2018	2019.01	05/24/2018 09:04:08 AM Central Daylight Time		07/27/2018 08:16:45 AM Central Daylight Time			07/27/2018 05:51:03 PM Central Daylight Time	MEMBERS HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	www.fbhealthplans.com/part-d/	Farm Bureau Select Rx (PDP)	10	29					S2668	006	0	2019	Alabama and Tennessee		2					2						fbhealthplans.com placeholder	www.fbhealthplans.com/part-d/selectrx										(866)643-6924		(866)643-6924		(866)643-6924		(866)643-6924										(711)-		(711)-		(711)-		(711)-																
S2874	001	0		29	10	S2874_001_0	3	1				05/26/2018	2019.01	05/26/2018 08:36:54 AM Eastern Daylight Time		05/31/2018 10:47:32 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S2874	001	0	2019	Puerto Rico - Island Wide		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-																
S2874	004	0		29	10	S2874_004_0	2	1				05/26/2018	2019.01	05/26/2018 08:39:15 AM Eastern Daylight Time		05/31/2018 10:48:10 AM Eastern Daylight Time			06/01/2018 10:26:27 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S2874	004	0	2019	Puerto Rico - Island Wide		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-																
S2874	801	0		29	10	S2874_801_0	2	1				05/17/2018	2019.01	05/17/2018 10:16:04 AM Eastern Daylight Time					05/31/2018 01:20:19 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S2874	801	0	2019	Puerto Rico - Island Wide		1					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-																
S2893	001	0		29	10	S2893_001_0	1	1				05/29/2018	2019.01	05/29/2018 10:29:28 AM Eastern Daylight Time		05/30/2018 10:38:03 AM Eastern Daylight Time			05/30/2018 10:49:19 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Value Plus (PDP)	10	29					S2893	001	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.rxmedicareplans.com	www.rxmedicareplans.com										(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(711)-		(711)-		(711)-		(711)-																
S2893	003	0		29	10	S2893_003_0	1	1				05/23/2018	2019.01	05/23/2018 11:21:35 AM Eastern Daylight Time		05/30/2018 10:38:05 AM Eastern Daylight Time			05/30/2018 10:42:54 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Premier (PDP)	10	29					S2893	003	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.rxmedicareplans.com	www.rxmedicareplans.com										(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(711)-		(711)-		(711)-		(711)-																
S2893	801	0		29	10	S2893_801_0	1	1				05/30/2018	2019.01	05/30/2018 10:16:23 AM Eastern Daylight Time					05/30/2018 10:22:43 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	801	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		1					2						www.rxmedicareplans.com	www.rxmedicareplans.com										(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(711)-		(711)-		(711)-		(711)-																
S2893	802	0		29	10	S2893_802_0	1	1				05/30/2018	2019.01	05/30/2018 10:15:49 AM Eastern Daylight Time					05/30/2018 10:33:06 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	802	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		1					2						www.rxmedicareplans.com	www.rxmedicareplans.com										(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(711)-		(711)-		(711)-		(711)-																
S3285	801	0		29	10	S3285_801_0	1	1				05/24/2018	2019.01	05/24/2018 02:26:54 PM Pacific Daylight Time					05/24/2018 02:41:37 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	801	0	2019	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	802	0		29	10	S3285_802_0	1	1				05/24/2018	2019.01	05/24/2018 02:33:21 PM Pacific Daylight Time					05/24/2018 02:41:37 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	802	0	2019	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	803	0		29	10	S3285_803_0	1	1				05/24/2018	2019.01	05/24/2018 02:33:42 PM Pacific Daylight Time					05/24/2018 02:41:37 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	803	0	2019	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	804	0		29	10	S3285_804_0	1	1				05/24/2018	2019.01	05/24/2018 02:33:51 PM Pacific Daylight Time					05/24/2018 02:41:37 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	804	0	2019	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	805	0		29	10	S3285_805_0	1	1				05/24/2018	2019.01	05/24/2018 02:34:11 PM Pacific Daylight Time					05/24/2018 02:41:37 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	805	0	2019	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	806	0		29	10	S3285_806_0	1	1				05/24/2018	2019.01	05/24/2018 02:34:22 PM Pacific Daylight Time					05/24/2018 02:41:37 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	806	0	2019	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	807	0		29	10	S3285_807_0	1	1				05/24/2018	2019.01	05/24/2018 02:34:31 PM Pacific Daylight Time					05/24/2018 02:41:37 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	807	0	2019	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3389	802	0		29	10	S3389_802_0	2	1				04/24/2018	2019.01	04/24/2018 10:32:10 AM Eastern Daylight Time					06/01/2018 08:32:29 PM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	802	0	2019	States of Pennsylvania and West Virginia		1					2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/										(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629																
S3389	803	0		29	10	S3389_803_0	2	1				04/24/2018	2019.01	04/24/2018 10:32:35 AM Eastern Daylight Time					06/01/2018 08:32:29 PM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	803	0	2019	States of Pennsylvania and West Virginia		1					2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/										(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629																
S3521	801	0		29	10	S3521_801_0	2	1				05/02/2018	2019.01	05/02/2018 11:41:31 AM Eastern Daylight Time					06/03/2018 10:52:09 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.SimplyPrescriptions.com	Simply Prescriptions- Employer Group (PDP)	10	29					S3521	801	0	2019	National and US Territories		1					2						www.SimplyPrescriptions.com	www.SimplyPrescriptions.com	www.SimplyPrescriptions.com									(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220																
S3875	802	0		29	10	S3875_802_0	1	1				06/01/2018	2019.01	06/01/2018 01:14:36 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	802	0	2019	Granite Alliance National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	803	0		29	10	S3875_803_0	1	1				06/01/2018	2019.01	06/01/2018 01:16:51 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance non-CY (PDP)	10	29					S3875	803	0	2019	Granite Alliance non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	804	0		29	10	S3875_804_0	1	1				06/01/2018	2019.01	06/01/2018 01:18:10 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	804	0	2019	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	805	0		29	10	S3875_805_0	1	1				06/01/2018	2019.01	06/01/2018 01:19:13 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other non-CY (PDP)	10	29					S3875	805	0	2019	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	806	0		29	10	S3875_806_0	1	1				06/01/2018	2019.01	06/01/2018 01:19:59 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	806	0	2019	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	807	0		29	10	S3875_807_0	1	1				06/01/2018	2019.01	06/01/2018 01:20:44 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other Non-CY (PDP)	10	29					S3875	807	0	2019	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	808	0		29	10	S3875_808_0	1	1				06/01/2018	2019.01	06/01/2018 01:21:17 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	808	0	2019	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	809	0		29	10	S3875_809_0	1	1				06/01/2018	2019.01	06/01/2018 01:21:57 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other Non-CY (PDP)	10	29					S3875	809	0	2019	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	810	0		29	10	S3875_810_0	1	1				06/01/2018	2019.01	06/01/2018 01:22:34 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	810	0	2019	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	811	0		29	10	S3875_811_0	1	1				06/01/2018	2019.01	06/01/2018 01:23:11 PM Mountain Daylight Time					06/01/2018 01:23:40 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other Non-CY (PDP)	10	29					S3875	811	0	2019	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3994	801	0		29	10	S3994_801_0	2	1				05/24/2018	2019.01	05/24/2018 08:24:19 AM Hawaiian Standard Time					06/01/2018 04:43:23 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSAs Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP CY (PDP)	10	29					S3994	801	0	2019	National		1					2						www.hmsa.com	www.hmsa.com										(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-																
S3994	802	0		29	10	S3994_802_0	2	1				04/11/2018	2019.01	04/11/2018 01:30:57 PM Hawaiian Standard Time					06/01/2018 04:44:37 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSAs Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP NCY (PDP)	10	29					S3994	802	0	2019	National		1					2						www.hmsa.com	www.hmsa.com										(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-																
S4219	801	0		29	10	S4219_801_0	1	1				04/23/2018	2019.01	04/23/2018 04:23:15 PM Central Daylight Time					06/05/2018 07:55:07 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.Healthalliancemedicare.org	Health Alliance Group Medicare Prescription Plan (PDP)	10	29					S4219	801	0	2019	United States		1					2						www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-																
S4219	802	0		29	10	S4219_802_0	1	1				04/23/2018	2019.01	04/23/2018 04:23:19 PM Central Daylight Time					06/05/2018 07:55:07 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.Healthalliancemedicare.org	Medicare Employer PDP (PDP) - non calendar year (PDP)	10	29					S4219	802	0	2019	United States		1					2						www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-																
S4501	801	0		29	10	S4501_801_0	1	1				06/01/2018	2019.01	06/01/2018 12:57:09 PM Eastern Daylight Time					06/01/2018 12:58:40 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	independenthealth.com/medicare	Pharmacy Benefit Dimensions PDP-1 (LMHF) (PDP)	10	29					S4501	801	0	2019	Western New York		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840																
S4501	802	0		29	10	S4501_802_0	1	1				04/24/2018	2019.01	04/24/2018 04:16:15 PM Eastern Daylight Time					06/01/2018 12:58:40 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-2 (PDP)	10	29					S4501	802	0	2019	All regions except MT, WY, ND, SD, NE, MN, IA		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	803	0		29	10	S4501_803_0	1	1				04/24/2018	2019.01	04/24/2018 04:16:25 PM Eastern Daylight Time					06/01/2018 12:58:40 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	independenthealth.com	Pharmacy Benefit Dimensions PDP-3 (PDP)	10	29					S4501	803	0	2019	All regions except: MT, WY, ND, SD, NE, MN, IA		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	804	0		29	10	S4501_804_0	1	1				04/24/2018	2019.01	04/24/2018 04:16:31 PM Eastern Daylight Time					06/01/2018 12:58:40 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-4 (PDP)	10	29					S4501	804	0	2019	All regions except MT, WY, ND, SD, NE, MN, IA		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	805	0		29	10	S4501_805_0	1	1				04/24/2018	2019.01	04/24/2018 04:16:42 PM Eastern Daylight Time					06/01/2018 12:58:40 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-5 (PDP)	10	29					S4501	805	0	2019	All regions except MT, WY, ND, SD, NE, MN, IA		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	806	0		29	10	S4501_806_0	1	1				04/24/2018	2019.01	04/24/2018 04:16:49 PM Eastern Daylight Time					06/01/2018 12:58:40 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-6 (PDP)	10	29					S4501	806	0	2019	All regions except MT, WY, ND, SD, NE, MN, IA		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	807	0		29	10	S4501_807_0	1	1				04/24/2018	2019.01	04/24/2018 04:17:26 PM Eastern Daylight Time					06/01/2018 12:58:40 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-7 (PDP)	10	29					S4501	807	0	2019	All regions except MT, WY, ND, SD, NE, MN, IA		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4607	002	0		29	10	S4607_002_0	1	1				06/02/2018	2019.01	06/02/2018 01:02:57 PM Central Daylight Time		06/02/2018 10:54:54 PM Central Daylight Time			06/02/2018 10:56:58 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	002	0	2019	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	003	0		29	10	S4607_003_0	1	1				06/02/2018	2019.01	06/02/2018 01:06:06 PM Central Daylight Time		06/02/2018 10:54:55 PM Central Daylight Time			06/02/2018 10:56:58 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	003	0	2019	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	009	0		29	10	S4607_009_0	1	1				06/02/2018	2019.01	06/02/2018 01:09:54 PM Central Daylight Time		06/02/2018 10:54:55 PM Central Daylight Time			06/02/2018 10:56:58 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	009	0	2019	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	023	0		29	10	S4607_023_0	1	1				06/02/2018	2019.01	06/02/2018 01:55:40 PM Central Daylight Time		06/02/2018 10:54:55 PM Central Daylight Time			06/02/2018 10:56:58 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	023	0	2019	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	801	0		29	10	S4607_801_0	2	1				06/01/2018	2019.01	06/01/2018 04:17:51 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	801	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	802	0		29	10	S4607_802_0	2	1				05/24/2018	2019.01	05/24/2018 01:47:01 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	802	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	803	0		29	10	S4607_803_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:00 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	803	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	804	0		29	10	S4607_804_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:06 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	804	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	805	0		29	10	S4607_805_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:11 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	805	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	806	0		29	10	S4607_806_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:17 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	806	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	807	0		29	10	S4607_807_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:24 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	https://medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	807	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						https://medicare.magellanrx.com	https://medicare.magellanrx.com	https://medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	808	0		29	10	S4607_808_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:31 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	808	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	809	0		29	10	S4607_809_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:37 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	809	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	810	0		29	10	S4607_810_0	2	1				05/24/2018	2019.01	05/24/2018 01:48:44 PM Central Daylight Time					06/02/2018 12:39:02 PM Central Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	810	0	2019	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4802	012	0		29	10	S4802_012_0	3	1				06/01/2018	2019.01	06/01/2018 11:52:36 AM Eastern Daylight Time		06/01/2018 05:19:30 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	012	0	2019	Louisiana		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	013	0		29	10	S4802_013_0	3	1				06/01/2018	2019.01	06/01/2018 11:53:10 AM Eastern Daylight Time		06/01/2018 05:20:12 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	013	0	2019	Texas		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	014	0		29	10	S4802_014_0	3	1				05/30/2018	2019.01	05/30/2018 05:57:15 PM Eastern Daylight Time		06/01/2018 05:20:53 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	014	0	2019	Oklahoma		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	020	0		29	10	S4802_020_0	3	1				05/25/2018	2019.01	05/25/2018 12:53:12 PM Eastern Daylight Time		06/01/2018 05:21:34 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	020	0	2019	Oregon and Washington		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	021	0		29	10	S4802_021_0	3	1				05/30/2018	2019.01	05/30/2018 05:59:16 PM Eastern Daylight Time		06/01/2018 05:22:15 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	021	0	2019	Idaho and Utah		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	069	0		29	10	S4802_069_0	4	1				05/30/2018	2019.01	05/30/2018 06:01:19 PM Eastern Daylight Time		07/23/2018 01:52:29 PM Eastern Daylight Time			07/24/2018 01:19:55 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	069	0	2019	Virginia		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	070	0		29	10	S4802_070_0	3	1				05/23/2018	2019.01	05/23/2018 03:17:38 PM Eastern Daylight Time		06/01/2018 05:23:39 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	070	0	2019	South Carolina		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	071	0		29	10	S4802_071_0	3	1				05/30/2018	2019.01	05/30/2018 06:03:21 PM Eastern Daylight Time		06/01/2018 05:24:20 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	071	0	2019	Alabama, Tennessee		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	072	0		29	10	S4802_072_0	3	1				05/30/2018	2019.01	05/30/2018 06:05:31 PM Eastern Daylight Time		06/01/2018 05:25:02 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	072	0	2019	Missouri		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	073	0		29	10	S4802_073_0	3	1				05/23/2018	2019.01	05/23/2018 03:21:36 PM Eastern Daylight Time		06/01/2018 05:25:43 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	073	0	2019	Arkansas		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	074	0		29	10	S4802_074_0	3	1				05/23/2018	2019.01	05/23/2018 03:22:02 PM Eastern Daylight Time		06/01/2018 05:26:24 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	074	0	2019	Mississippi		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	075	0		29	10	S4802_075_0	3	1				05/30/2018	2019.01	05/30/2018 06:07:29 PM Eastern Daylight Time		06/01/2018 05:27:05 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	075	0	2019	Maine, New Hampshire		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	076	0		29	10	S4802_076_0	3	1				05/30/2018	2019.01	05/30/2018 06:08:54 PM Eastern Daylight Time		06/01/2018 05:27:46 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	076	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	077	0		29	10	S4802_077_0	3	1				05/30/2018	2019.01	05/30/2018 06:10:18 PM Eastern Daylight Time		06/01/2018 05:28:27 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	077	0	2019	New York		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	078	0		29	10	S4802_078_0	3	1				05/30/2018	2019.01	05/30/2018 06:11:41 PM Eastern Daylight Time		06/01/2018 05:29:08 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	078	0	2019	New Jersey		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	079	0		29	10	S4802_079_0	3	1				05/30/2018	2019.01	05/30/2018 06:13:00 PM Eastern Daylight Time		06/01/2018 05:29:50 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	079	0	2019	District of Columbia, Delaware, Maryland		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	080	0		29	10	S4802_080_0	3	1				05/30/2018	2019.01	05/30/2018 06:06:30 PM Eastern Daylight Time		06/01/2018 05:30:32 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	080	0	2019	Pennsylvania, West Virginia		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	081	0		29	10	S4802_081_0	3	1				05/30/2018	2019.01	05/30/2018 06:08:40 PM Eastern Daylight Time		06/01/2018 05:31:13 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	081	0	2019	North Carolina		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	082	0		29	10	S4802_082_0	3	1				05/23/2018	2019.01	05/23/2018 03:32:45 PM Eastern Daylight Time		06/01/2018 05:31:54 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	082	0	2019	Georgia		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	083	0		29	10	S4802_083_0	3	1				06/01/2018	2019.01	06/01/2018 10:35:23 AM Eastern Daylight Time		06/01/2018 05:32:35 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	083	0	2019	Florida		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	084	0		29	10	S4802_084_0	3	1				05/30/2018	2019.01	05/30/2018 05:55:36 PM Eastern Daylight Time		06/01/2018 05:33:16 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	084	0	2019	Michigan		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	085	0		29	10	S4802_085_0	3	1				05/30/2018	2019.01	05/30/2018 05:56:50 PM Eastern Daylight Time		06/01/2018 05:33:57 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	085	0	2019	Ohio		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	086	0		29	10	S4802_086_0	3	1				05/30/2018	2019.01	05/30/2018 05:57:58 PM Eastern Daylight Time		06/01/2018 05:34:38 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	086	0	2019	Indiana, Kentucky		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	087	0		29	10	S4802_087_0	3	1				05/23/2018	2019.01	05/23/2018 03:39:37 PM Eastern Daylight Time		06/01/2018 05:35:20 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	087	0	2019	Illinois		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	088	0		29	10	S4802_088_0	3	1				05/30/2018	2019.01	05/30/2018 05:59:03 PM Eastern Daylight Time		06/01/2018 05:36:01 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	088	0	2019	Kansas		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	089	0		29	10	S4802_089_0	3	1				05/23/2018	2019.01	05/23/2018 03:41:22 PM Eastern Daylight Time		06/01/2018 05:36:42 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	089	0	2019	IA, MN, MT, NE, ND, SD, WY		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	090	0		29	10	S4802_090_0	3	1				06/01/2018	2019.01	06/01/2018 01:40:55 PM Eastern Daylight Time		06/01/2018 05:37:24 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	090	0	2019	New Mexico		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	091	0		29	10	S4802_091_0	3	1				05/23/2018	2019.01	05/23/2018 03:43:36 PM Eastern Daylight Time		06/01/2018 05:38:06 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	091	0	2019	Colorado		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	092	0		29	10	S4802_092_0	4	1				05/23/2018	2019.01	05/23/2018 03:44:44 PM Eastern Daylight Time		07/23/2018 01:51:11 PM Eastern Daylight Time			07/24/2018 01:19:55 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	092	0	2019	Arizona		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	093	0		29	10	S4802_093_0	3	1				05/23/2018	2019.01	05/23/2018 03:45:29 PM Eastern Daylight Time		06/01/2018 05:39:29 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	093	0	2019	Nevada		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	094	0		29	10	S4802_094_0	3	1				05/30/2018	2019.01	05/30/2018 06:00:20 PM Eastern Daylight Time		06/01/2018 05:40:10 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	094	0	2019	California		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	095	0		29	10	S4802_095_0	3	1				05/27/2018	2019.01	05/27/2018 09:45:51 AM Eastern Daylight Time		06/01/2018 05:40:51 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	095	0	2019	Hawaii		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	096	0		29	10	S4802_096_0	3	1				05/30/2018	2019.01	05/30/2018 06:01:29 PM Eastern Daylight Time		06/01/2018 05:41:32 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	096	0	2019	Alaska		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	097	0		29	10	S4802_097_0	3	1				05/30/2018	2019.01	05/30/2018 06:02:50 PM Eastern Daylight Time		06/01/2018 05:42:13 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	097	0	2019	Wisconsin		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	098	0		29	10	S4802_098_0	3	1				05/27/2018	2019.01	05/27/2018 11:58:02 AM Eastern Daylight Time		06/01/2018 05:42:54 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	098	0	2019	Maine, New Hampshire		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	099	0		29	10	S4802_099_0	3	1				05/27/2018	2019.01	05/27/2018 12:00:57 PM Eastern Daylight Time		06/01/2018 05:43:35 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	099	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	100	0		29	10	S4802_100_0	3	1				06/01/2018	2019.01	06/01/2018 11:53:54 AM Eastern Daylight Time		06/01/2018 05:44:17 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	100	0	2019	New York		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	101	0		29	10	S4802_101_0	3	1				06/01/2018	2019.01	06/01/2018 11:54:55 AM Eastern Daylight Time		06/01/2018 05:45:00 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	101	0	2019	New Jersey		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	102	0		29	10	S4802_102_0	3	1				05/27/2018	2019.01	05/27/2018 12:00:59 PM Eastern Daylight Time		06/01/2018 05:45:44 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	102	0	2019	District of Columbia, Delaware, Maryland		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	103	0		29	10	S4802_103_0	3	1				05/27/2018	2019.01	05/27/2018 12:00:59 PM Eastern Daylight Time		06/01/2018 05:46:29 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	103	0	2019	Pennsylvania, West Virginia		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	104	0		29	10	S4802_104_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:00 PM Eastern Daylight Time		06/01/2018 05:47:13 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	104	0	2019	Virginia		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	105	0		29	10	S4802_105_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:00 PM Eastern Daylight Time		06/01/2018 05:48:01 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	105	0	2019	North Carolina		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	106	0		29	10	S4802_106_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:00 PM Eastern Daylight Time		06/01/2018 05:48:49 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	106	0	2019	South Carolina		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	107	0		29	10	S4802_107_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:01 PM Eastern Daylight Time		06/01/2018 05:49:34 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	107	0	2019	Georgia		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	108	0		29	10	S4802_108_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:01 PM Eastern Daylight Time		06/01/2018 05:50:16 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	108	0	2019	Florida		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	109	0		29	10	S4802_109_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:01 PM Eastern Daylight Time		06/01/2018 05:50:57 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	109	0	2019	Alabama, Tennessee		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	110	0		29	10	S4802_110_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:01 PM Eastern Daylight Time		06/01/2018 05:51:38 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	110	0	2019	Michigan		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	111	0		29	10	S4802_111_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:01 PM Eastern Daylight Time		06/01/2018 05:52:19 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	111	0	2019	Ohio		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	112	0		29	10	S4802_112_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:01 PM Eastern Daylight Time		06/01/2018 05:53:00 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	112	0	2019	Indiana, Kentucky		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	113	0		29	10	S4802_113_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:02 PM Eastern Daylight Time		06/01/2018 05:53:41 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	113	0	2019	Illinois		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	114	0		29	10	S4802_114_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:02 PM Eastern Daylight Time		06/01/2018 05:54:22 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	114	0	2019	Missouri		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	115	0		29	10	S4802_115_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:02 PM Eastern Daylight Time		06/01/2018 05:55:13 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	115	0	2019	Arkansas		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	116	0		29	10	S4802_116_0	3	1				05/27/2018	2019.01	05/27/2018 12:03:16 PM Eastern Daylight Time		06/01/2018 05:55:55 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	116	0	2019	Mississippi		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	118	0		29	10	S4802_118_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:03 PM Eastern Daylight Time		06/01/2018 05:56:40 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	118	0	2019	Texas		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	119	0		29	10	S4802_119_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:03 PM Eastern Daylight Time		06/01/2018 05:57:24 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	119	0	2019	Oklahoma		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	120	0		29	10	S4802_120_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:03 PM Eastern Daylight Time		06/01/2018 05:58:07 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	120	0	2019	Kansas		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	121	0		29	10	S4802_121_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:03 PM Eastern Daylight Time		06/01/2018 05:58:51 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	121	0	2019	IA, MN, MT, NE, ND, SD, WY		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	122	0		29	10	S4802_122_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:04 PM Eastern Daylight Time		06/01/2018 05:59:34 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	122	0	2019	New Mexico		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	123	0		29	10	S4802_123_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:04 PM Eastern Daylight Time		06/01/2018 06:00:17 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	123	0	2019	Colorado		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	125	0		29	10	S4802_125_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:04 PM Eastern Daylight Time		06/01/2018 06:00:59 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	125	0	2019	Nevada		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	127	0		29	10	S4802_127_0	3	1				05/27/2018	2019.01	05/27/2018 12:04:43 PM Eastern Daylight Time		06/01/2018 06:01:41 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	127	0	2019	Idaho, Utah		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	128	0		29	10	S4802_128_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:04 PM Eastern Daylight Time		06/01/2018 06:02:21 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	128	0	2019	California		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	129	0		29	10	S4802_129_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:05 PM Eastern Daylight Time		06/01/2018 06:03:02 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	129	0	2019	Hawaii		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	130	0		29	10	S4802_130_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:05 PM Eastern Daylight Time		06/01/2018 06:03:43 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	130	0	2019	Alaska		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	132	0		29	10	S4802_132_0	5	1				05/27/2018	2019.01	05/27/2018 09:53:18 AM Eastern Daylight Time		07/18/2018 10:36:18 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	132	0	2019	Wisconsin		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	133	0		29	10	S4802_133_0	5	1				05/27/2018	2019.01	05/27/2018 10:04:55 AM Eastern Daylight Time		07/18/2018 10:37:06 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	133	0	2019	Louisiana		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	134	0		29	10	S4802_134_0	5	1				05/27/2018	2019.01	05/27/2018 10:04:30 AM Eastern Daylight Time		07/18/2018 10:37:54 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	134	0	2019	Arizona		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	135	0		29	10	S4802_135_0	5	1				05/27/2018	2019.01	05/27/2018 10:08:26 AM Eastern Daylight Time		07/18/2018 10:38:38 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	135	0	2019	Oregon, Washington		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	136	0		29	10	S4802_136_0	5	1				05/27/2018	2019.01	05/27/2018 10:14:53 AM Eastern Daylight Time		07/18/2018 10:39:19 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	136	0	2019	Maine, New Hampshire		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	137	0		29	10	S4802_137_0	5	1				05/27/2018	2019.01	05/27/2018 10:13:48 AM Eastern Daylight Time		07/18/2018 10:40:01 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	137	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	138	0		29	10	S4802_138_0	5	1				05/27/2018	2019.01	05/27/2018 10:18:55 AM Eastern Daylight Time		07/18/2018 10:40:42 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	138	0	2019	New York		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	139	0		29	10	S4802_139_0	5	1				05/27/2018	2019.01	05/27/2018 10:21:39 AM Eastern Daylight Time		07/18/2018 10:41:23 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	139	0	2019	New Jersey		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	140	0		29	10	S4802_140_0	5	1				06/01/2018	2019.01	06/01/2018 11:57:02 AM Eastern Daylight Time		07/18/2018 10:42:04 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	140	0	2019	District of Columbia, Delaware, Maryland		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	141	0		29	10	S4802_141_0	5	1				05/27/2018	2019.01	05/27/2018 10:28:49 AM Eastern Daylight Time		07/18/2018 10:42:45 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	141	0	2019	Pennsylvania, West Virginia		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	142	0		29	10	S4802_142_0	5	1				05/27/2018	2019.01	05/27/2018 10:36:51 AM Eastern Daylight Time		07/18/2018 10:43:26 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	142	0	2019	Virginia		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	143	0		29	10	S4802_143_0	5	1				05/27/2018	2019.01	05/27/2018 10:41:14 AM Eastern Daylight Time		07/18/2018 10:44:08 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	143	0	2019	North Carolina		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	144	0		29	10	S4802_144_0	5	1				05/27/2018	2019.01	05/27/2018 11:12:22 AM Eastern Daylight Time		07/18/2018 10:44:49 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	144	0	2019	South Carolina		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	145	0		29	10	S4802_145_0	5	1				05/27/2018	2019.01	05/27/2018 11:13:55 AM Eastern Daylight Time		07/18/2018 10:45:30 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	145	0	2019	Georgia		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	146	0		29	10	S4802_146_0	5	1				05/27/2018	2019.01	05/27/2018 11:15:10 AM Eastern Daylight Time		07/18/2018 10:46:12 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	146	0	2019	Florida		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	147	0		29	10	S4802_147_0	5	1				05/27/2018	2019.01	05/27/2018 11:16:35 AM Eastern Daylight Time		07/18/2018 10:46:53 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	147	0	2019	Alabama, Tennessee		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	148	0		29	10	S4802_148_0	5	1				05/27/2018	2019.01	05/27/2018 11:17:35 AM Eastern Daylight Time		07/18/2018 10:47:34 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	148	0	2019	Michigan		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	149	0		29	10	S4802_149_0	5	1				05/27/2018	2019.01	05/27/2018 11:18:40 AM Eastern Daylight Time		07/18/2018 10:48:15 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	149	0	2019	Ohio		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	150	0		29	10	S4802_150_0	5	1				05/27/2018	2019.01	05/27/2018 11:19:43 AM Eastern Daylight Time		07/18/2018 10:48:56 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	150	0	2019	Indiana, Kentucky		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	151	0		29	10	S4802_151_0	5	1				05/27/2018	2019.01	05/27/2018 11:21:15 AM Eastern Daylight Time		07/18/2018 10:49:37 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	151	0	2019	Illinois		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	152	0		29	10	S4802_152_0	5	1				05/27/2018	2019.01	05/27/2018 11:23:34 AM Eastern Daylight Time		07/18/2018 10:50:28 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	152	0	2019	Missouri		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	153	0		29	10	S4802_153_0	5	1				05/27/2018	2019.01	05/27/2018 11:35:02 AM Eastern Daylight Time		07/18/2018 10:51:13 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	153	0	2019	Arkansas		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	154	0		29	10	S4802_154_0	5	1				05/27/2018	2019.01	05/27/2018 11:36:19 AM Eastern Daylight Time		07/18/2018 10:51:53 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	154	0	2019	Mississippi		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	155	0		29	10	S4802_155_0	5	1				05/27/2018	2019.01	05/27/2018 11:37:32 AM Eastern Daylight Time		07/18/2018 10:52:34 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	155	0	2019	Texas		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	156	0		29	10	S4802_156_0	5	1				05/27/2018	2019.01	05/27/2018 11:38:46 AM Eastern Daylight Time		07/18/2018 10:53:15 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	156	0	2019	Oklahoma		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	157	0		29	10	S4802_157_0	5	1				05/27/2018	2019.01	05/27/2018 11:40:41 AM Eastern Daylight Time		07/18/2018 10:53:56 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	157	0	2019	Kansas		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	158	0		29	10	S4802_158_0	5	1				05/27/2018	2019.01	05/27/2018 11:41:48 AM Eastern Daylight Time		07/18/2018 10:54:37 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	158	0	2019	IA, MN, MT, ND, NE, SD, WY		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	159	0		29	10	S4802_159_0	5	1				05/27/2018	2019.01	05/27/2018 11:43:08 AM Eastern Daylight Time		07/18/2018 10:55:18 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	159	0	2019	New Mexico		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	160	0		29	10	S4802_160_0	5	1				05/27/2018	2019.01	05/27/2018 11:44:10 AM Eastern Daylight Time		07/18/2018 10:55:59 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	160	0	2019	Colorado		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	161	0		29	10	S4802_161_0	5	1				05/27/2018	2019.01	05/27/2018 11:45:28 AM Eastern Daylight Time		07/18/2018 10:56:40 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	161	0	2019	Nevada		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	162	0		29	10	S4802_162_0	5	1				05/27/2018	2019.01	05/27/2018 11:46:48 AM Eastern Daylight Time		07/18/2018 10:57:20 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	162	0	2019	Idaho, Utah		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	163	0		29	10	S4802_163_0	5	1				05/27/2018	2019.01	05/27/2018 11:48:23 AM Eastern Daylight Time		07/18/2018 10:58:01 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	163	0	2019	California		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	164	0		29	10	S4802_164_0	5	1				05/27/2018	2019.01	05/27/2018 11:50:05 AM Eastern Daylight Time		07/18/2018 10:58:42 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	164	0	2019	Hawaii		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	165	0		29	10	S4802_165_0	5	1				06/01/2018	2019.01	06/01/2018 11:55:42 AM Eastern Daylight Time		07/18/2018 10:59:23 PM Eastern Daylight Time			07/19/2018 05:38:34 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Value Script (PDP)	10	29					S4802	165	0	2019	Alaska		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	166	0		29	10	S4802_166_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:05 PM Eastern Daylight Time		06/01/2018 06:27:54 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	166	0	2019	Wisconsin		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	167	0		29	10	S4802_167_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:05 PM Eastern Daylight Time		06/01/2018 06:28:36 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	167	0	2019	Louisiana		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	168	0		29	10	S4802_168_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:06 PM Eastern Daylight Time		06/01/2018 06:29:18 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	168	0	2019	Arizona		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	169	0		29	10	S4802_169_0	3	1				05/27/2018	2019.01	05/27/2018 12:01:06 PM Eastern Daylight Time		06/01/2018 06:30:00 PM Eastern Daylight Time			06/02/2018 11:02:33 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S4802	169	0	2019	Oregon, Washington		2					2						www.wellcarepdp.com	www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5450	801	0		29	10	S5450_801_0	1	1				05/25/2018	2019.01	05/25/2018 10:36:08 AM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	801	0	2019	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	802	0		29	10	S5450_802_0	1	1				05/03/2018	2019.01	05/03/2018 02:17:54 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	802	0	2019	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	803	0		29	10	S5450_803_0	1	1				05/03/2018	2019.01	05/03/2018 02:18:10 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	803	0	2019	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	804	0		29	10	S5450_804_0	1	1				05/03/2018	2019.01	05/03/2018 02:18:24 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	804	0	2019	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	805	0		29	10	S5450_805_0	1	1				05/03/2018	2019.01	05/03/2018 02:18:40 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	805	0	2019	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	806	0		29	10	S5450_806_0	1	1				05/03/2018	2019.01	05/03/2018 02:18:54 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	806	0	2019	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	807	0		29	10	S5450_807_0	1	1				05/03/2018	2019.01	05/03/2018 02:19:09 PM Eastern Daylight Time					06/01/2018 04:15:53 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	807	0	2019	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5540	002	0		29	10	S5540_002_0	2	1				05/31/2018	2019.01	05/31/2018 02:19:25 PM Eastern Daylight Time		05/31/2018 02:04:41 PM Eastern Daylight Time			05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx Standard (PDP)	10	29					S5540	002	0	2019	North Carolina		2					2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140																
S5540	004	0		29	10	S5540_004_0	2	1				05/22/2018	2019.01	05/22/2018 01:33:08 PM Eastern Daylight Time		05/31/2018 02:04:51 PM Eastern Daylight Time			05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx Enhanced (PDP)	10	29					S5540	004	0	2019	North Carolina		2					2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140																
S5540	801	0		29	10	S5540_801_0	2	1				05/22/2018	2019.01	05/22/2018 12:24:03 PM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx EGWP (PDP)	10	29					S5540	801	0	2019	National Employer Group Retirees		1					2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140																
S5540	802	0		29	10	S5540_802_0	2	1				04/18/2018	2019.01	04/18/2018 12:39:43 PM Eastern Daylight Time					05/31/2018 02:24:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx EGWP Value (PDP)	10	29					S5540	802	0	2019	NC Employer Groups		1					2						www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140																
S5552	003	0		29	10	S5552_003_0	3	1				05/25/2018	2019.01	05/25/2018 03:34:26 PM Eastern Daylight Time		05/31/2018 10:48:49 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5552	003	0	2019	State of New York		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	004	0		29	10	S5552_004_0	3	1				06/01/2018	2019.01	06/01/2018 07:59:41 AM Eastern Daylight Time		07/17/2018 09:07:52 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5552	004	0	2019	State of New York		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	005	0		29	10	S5552_005_0	3	1				05/20/2018	2019.01	05/20/2018 12:38:11 PM Eastern Daylight Time		05/31/2018 10:50:16 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5552	005	0	2019	State of New York		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	801	0		29	10	S5552_801_0	2	1				05/17/2018	2019.01	05/17/2018 10:18:09 AM Eastern Daylight Time					05/31/2018 01:20:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5552	801	0	2019	State of New York		1					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-																
S5584	001	0		29	10	S5584_001_0	3	1				06/03/2018	2019.01	06/03/2018 02:16:47 PM Eastern Daylight Time		06/04/2018 08:28:10 PM Eastern Daylight Time			06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Select (PDP)	10	29					S5584	001	0	2019	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	002	0		29	10	S5584_002_0	3	1				06/02/2018	2019.01	06/02/2018 04:50:24 PM Eastern Daylight Time		06/04/2018 08:28:11 PM Eastern Daylight Time			06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Premium (PDP)	10	29					S5584	002	0	2019	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	005	0		29	10	S5584_005_0	3	1				06/01/2018	2019.01	06/01/2018 05:32:49 PM Eastern Daylight Time		06/04/2018 08:28:11 PM Eastern Daylight Time			06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Preferred (PDP)	10	29					S5584	005	0	2019	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(800)565-1770		(800)565-1770										(711)-		(711)-		(711)-		(711)-																
S5584	801	0		29	10	S5584_801_0	2	1				05/01/2018	2019.01	05/01/2018 03:26:14 PM Eastern Daylight Time					06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Employer Plan CY (PDP)	10	29					S5584	801	0	2019	State of Michigan		1					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-																
S5584	802	0		29	10	S5584_802_0	2	1				04/18/2018	2019.01	04/18/2018 07:59:35 PM Eastern Daylight Time					06/04/2018 08:52:45 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Employer Plan non-CY (PDP)	10	29					S5584	802	0	2019	State of Michigan		1					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-																
S5588	802	0		29	10	S5588_802_0	1	1				05/24/2018	2019.01	05/24/2018 12:34:03 PM Eastern Daylight Time					05/25/2018 04:18:44 PM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	www.paramounthealthcare.com	Paramount Std. Prescription Drug Plan Empl (PDP)	10	29					S5588	802	0	2019	Paramount Standard Prescription Drug Plan (Ohio)		1					2						www.paramounthealthcare.com/medicareplans	www.paramounthealthcare.com/medicareplans										(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670																
S5588	803	0		29	10	S5588_803_0	1	1				05/24/2018	2019.01	05/24/2018 12:35:23 PM Eastern Daylight Time					05/25/2018 04:18:44 PM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	www.paramounthealthcare.com	Paramount Enh. Prescription Drug Plan Empl (PDP)	10	29					S5588	803	0	2019	Paramount Enhanced Prescription Drug Plan (Ohio)		1					2						www.paramounthealthcare.com/medicareplans	www.paramounthealthcare.com/medicareplans										(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670																
S5593	002	0		29	10	S5593_002_0	4	1				05/18/2018	2019.01	05/18/2018 02:04:48 PM Eastern Daylight Time		05/31/2018 01:17:55 PM Eastern Daylight Time			06/01/2018 03:43:00 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Plus (PDP)	10	29					S5593	002	0	2019	Pennsylvania  and West Virginia		2					2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	003	0		29	10	S5593_003_0	4	1				05/18/2018	2019.01	05/18/2018 02:06:34 PM Eastern Daylight Time		05/31/2018 01:19:30 PM Eastern Daylight Time			06/01/2018 03:43:00 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Complete (PDP)	10	29					S5593	003	0	2019	Pennsylvania  and West Virginia		2					2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	801	0		29	10	S5593_801_0	4	1				05/02/2018	2019.01	05/02/2018 02:28:05 PM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Employer Group Calendar (PDP)	10	29					S5593	801	0	2019	National		1					2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	802	0		29	10	S5593_802_0	4	1				05/02/2018	2019.01	05/02/2018 02:28:13 PM Eastern Daylight Time					06/01/2018 03:43:00 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Employer Group Non-Calendar (PDP)	10	29					S5593	802	0	2019	National		1					2						www.highmarkblueshield.com/medicare	www.highmarkblueshield.com/medicare										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5596	001	0		29	10	S5596_001_0	1	1				05/30/2018	2019.01	05/30/2018 01:24:48 PM Eastern Daylight Time		05/30/2018 04:43:12 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	001	0	2019	Maine and New Hampshire		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	005	0		29	10	S5596_005_0	3	1				07/13/2018	2019.01	07/13/2018 02:07:32 PM Eastern Daylight Time		07/10/2018 03:04:37 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	005	0	2019	Virginia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	006	0		29	10	S5596_006_0	1	1				05/23/2018	2019.01	05/23/2018 08:51:30 AM Eastern Daylight Time		05/30/2018 04:45:03 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	006	0	2019	Virginia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	009	0		29	10	S5596_009_0	2	1				05/30/2018	2019.01	05/30/2018 01:26:59 PM Eastern Daylight Time		07/10/2018 03:05:37 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	009	0	2019	Georgia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	010	0		29	10	S5596_010_0	1	1				05/23/2018	2019.01	05/23/2018 09:07:41 AM Eastern Daylight Time		05/30/2018 04:46:49 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	010	0	2019	Georgia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	013	0		29	10	S5596_013_0	2	1				05/30/2018	2019.01	05/30/2018 01:27:54 PM Eastern Daylight Time		07/10/2018 03:06:36 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	013	0	2019	Ohio		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	014	0		29	10	S5596_014_0	1	1				05/23/2018	2019.01	05/23/2018 09:12:24 AM Eastern Daylight Time		05/30/2018 04:48:37 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	014	0	2019	Ohio		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	017	0		29	10	S5596_017_0	2	1				05/30/2018	2019.01	05/30/2018 01:28:40 PM Eastern Daylight Time		07/10/2018 03:07:42 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	017	0	2019	Indiana and Kentucky		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	018	0		29	10	S5596_018_0	1	1				05/23/2018	2019.01	05/23/2018 09:17:18 AM Eastern Daylight Time		05/30/2018 04:50:52 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	018	0	2019	Indiana and Kentucky		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	033	0		29	10	S5596_033_0	2	1				05/30/2018	2019.01	05/30/2018 01:29:39 PM Eastern Daylight Time		07/10/2018 03:08:40 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue Cross MedicareRx Standard (PDP)	10	29					S5596	033	0	2019	California		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	034	0		29	10	S5596_034_0	2	1				05/23/2018	2019.01	05/23/2018 09:20:18 AM Eastern Daylight Time		05/30/2018 04:53:11 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue Cross MedicareRx Plus (PDP)	10	29					S5596	034	0	2019	California		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	043	0		29	10	S5596_043_0	2	1				05/30/2018	2019.01	05/30/2018 01:30:57 PM Eastern Daylight Time		07/10/2018 03:09:39 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5596	043	0	2019	Missouri		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	044	0		29	10	S5596_044_0	1	1				05/23/2018	2019.01	05/23/2018 09:24:27 AM Eastern Daylight Time		05/30/2018 04:55:03 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5596	044	0	2019	Missouri		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	046	0		29	10	S5596_046_0	2	1				05/30/2018	2019.01	05/30/2018 01:31:54 PM Eastern Daylight Time		07/10/2018 03:10:43 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	046	0	2019	Maine and New Hampshire		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	056	0		29	10	S5596_056_0	2	1				05/30/2018	2019.01	05/30/2018 01:33:56 PM Eastern Daylight Time		07/10/2018 03:11:44 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	056	0	2019	Wisconsin		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	057	0		29	10	S5596_057_0	1	1				05/23/2018	2019.01	05/23/2018 09:29:05 AM Eastern Daylight Time		05/30/2018 04:57:44 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	057	0	2019	Wisconsin		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	059	0		29	10	S5596_059_0	2	1				05/30/2018	2019.01	05/30/2018 01:34:38 PM Eastern Daylight Time		07/10/2018 03:12:52 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	059	0	2019	Colorado		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	060	0		29	10	S5596_060_0	1	1				05/23/2018	2019.01	05/23/2018 09:32:15 AM Eastern Daylight Time		05/30/2018 04:59:36 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	060	0	2019	Colorado		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	062	0		29	10	S5596_062_0	2	1				05/30/2018	2019.01	05/30/2018 01:35:26 PM Eastern Daylight Time		07/10/2018 03:13:56 PM Eastern Daylight Time			07/13/2018 02:12:33 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	062	0	2019	Nevada		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	063	0		29	10	S5596_063_0	1	1				05/23/2018	2019.01	05/23/2018 09:35:23 AM Eastern Daylight Time		05/30/2018 05:01:21 PM Eastern Daylight Time			06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	063	0	2019	Nevada		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	803	0		29	10	S5596_803_0	1	1				06/01/2018	2019.01	06/01/2018 09:46:10 AM Eastern Daylight Time					06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	803	0	2019	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5596	804	0		29	10	S5596_804_0	1	1				06/01/2018	2019.01	06/01/2018 09:46:17 AM Eastern Daylight Time					06/01/2018 09:46:48 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	804	0	2019	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5601	002	0		29	10	S5601_002_0	3	1				06/01/2018	2019.01	06/01/2018 06:43:54 PM Eastern Daylight Time		06/01/2018 11:39:46 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	002	0	2019	Northern New England SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	003	0		29	10	S5601_003_0	3	1				06/02/2018	2019.01	06/02/2018 10:18:19 AM Eastern Daylight Time		06/01/2018 12:31:45 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	003	0	2019	Northern New England SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	004	0		29	10	S5601_004_0	1	1				06/01/2018	2019.01	06/01/2018 06:47:29 PM Eastern Daylight Time		06/01/2018 11:41:03 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	004	0	2019	Central New England SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	005	0		29	10	S5601_005_0	1	1				06/01/2018	2019.01	06/01/2018 07:10:07 PM Eastern Daylight Time		06/01/2018 12:33:10 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	005	0	2019	Central New England SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	006	0		29	10	S5601_006_0	2	1				06/01/2018	2019.01	06/01/2018 06:48:07 PM Eastern Daylight Time		06/03/2018 10:20:51 AM Eastern Daylight Time			06/03/2018 12:49:47 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	006	0	2019	New York SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	007	0		29	10	S5601_007_0	1	1				06/01/2018	2019.01	06/01/2018 07:09:43 PM Eastern Daylight Time		06/01/2018 12:34:35 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	007	0	2019	New York SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	008	0		29	10	S5601_008_0	1	1				06/01/2018	2019.01	06/01/2018 06:48:48 PM Eastern Daylight Time		06/01/2018 11:46:19 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	008	0	2019	New Jersey SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	009	0		29	10	S5601_009_0	1	1				06/01/2018	2019.01	06/01/2018 07:10:37 PM Eastern Daylight Time		06/01/2018 12:36:02 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	009	0	2019	New Jersey SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	010	0		29	10	S5601_010_0	1	1				06/01/2018	2019.01	06/01/2018 06:49:35 PM Eastern Daylight Time		06/01/2018 11:47:48 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	010	0	2019	Mid-Atlantic SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	011	0		29	10	S5601_011_0	1	1				06/01/2018	2019.01	06/01/2018 07:11:05 PM Eastern Daylight Time		06/01/2018 12:37:26 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	011	0	2019	Mid-Atlantic SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	012	0		29	10	S5601_012_0	1	1				06/01/2018	2019.01	06/01/2018 06:50:09 PM Eastern Daylight Time		06/01/2018 11:49:13 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	012	0	2019	Pennsylvania, West Virginia SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	013	0		29	10	S5601_013_0	1	1				06/01/2018	2019.01	06/01/2018 07:11:31 PM Eastern Daylight Time		06/01/2018 12:38:50 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	013	0	2019	Pennsylvania, West Virginia SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	014	0		29	10	S5601_014_0	1	1				06/01/2018	2019.01	06/01/2018 06:50:38 PM Eastern Daylight Time		06/01/2018 11:50:41 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	014	0	2019	Virginia SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	015	0		29	10	S5601_015_0	1	1				06/01/2018	2019.01	06/01/2018 07:12:00 PM Eastern Daylight Time		06/01/2018 12:40:14 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	015	0	2019	Virginia SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	016	0		29	10	S5601_016_0	1	1				06/01/2018	2019.01	06/01/2018 06:51:26 PM Eastern Daylight Time		06/01/2018 11:09:15 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	016	0	2019	North Carolina SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	017	0		29	10	S5601_017_0	1	1				06/01/2018	2019.01	06/01/2018 07:12:30 PM Eastern Daylight Time		06/01/2018 12:41:37 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	017	0	2019	North Carolina SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	018	0		29	10	S5601_018_0	1	1				06/01/2018	2019.01	06/01/2018 06:51:58 PM Eastern Daylight Time		06/01/2018 04:47:35 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	018	0	2019	South Carolina SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	019	0		29	10	S5601_019_0	1	1				06/01/2018	2019.01	06/01/2018 07:13:04 PM Eastern Daylight Time		06/01/2018 12:43:01 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	019	0	2019	South Carolina SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	020	0		29	10	S5601_020_0	1	1				06/01/2018	2019.01	06/01/2018 06:52:27 PM Eastern Daylight Time		06/01/2018 04:48:58 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	020	0	2019	Georgia SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	021	0		29	10	S5601_021_0	1	1				06/01/2018	2019.01	06/01/2018 07:13:39 PM Eastern Daylight Time		06/01/2018 12:44:30 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	021	0	2019	Georgia SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	022	0		29	10	S5601_022_0	2	1				06/01/2018	2019.01	06/01/2018 06:52:57 PM Eastern Daylight Time		07/20/2018 11:29:56 AM Eastern Daylight Time			07/20/2018 11:31:24 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	022	0	2019	Florida SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	023	0		29	10	S5601_023_0	1	1				06/01/2018	2019.01	06/01/2018 07:14:17 PM Eastern Daylight Time		06/01/2018 12:45:57 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	023	0	2019	Florida SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	024	0		29	10	S5601_024_0	1	1				06/01/2018	2019.01	06/01/2018 06:53:26 PM Eastern Daylight Time		06/01/2018 11:58:12 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	024	0	2019	Alabama, Tennessee SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	025	0		29	10	S5601_025_0	1	1				06/01/2018	2019.01	06/01/2018 07:14:45 PM Eastern Daylight Time		06/01/2018 12:47:22 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	025	0	2019	Alabama, Tennessee SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	026	0		29	10	S5601_026_0	1	1				06/01/2018	2019.01	06/01/2018 06:53:58 PM Eastern Daylight Time		06/01/2018 11:59:37 AM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	026	0	2019	Michigan SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	027	0		29	10	S5601_027_0	1	1				06/01/2018	2019.01	06/01/2018 07:15:13 PM Eastern Daylight Time		06/01/2018 12:48:45 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	027	0	2019	Michigan SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	028	0		29	10	S5601_028_0	1	1				06/02/2018	2019.01	06/02/2018 01:22:22 PM Eastern Daylight Time		06/01/2018 12:01:04 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	028	0	2019	Ohio SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	029	0		29	10	S5601_029_0	1	1				06/01/2018	2019.01	06/01/2018 07:15:45 PM Eastern Daylight Time		06/01/2018 12:50:09 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	029	0	2019	Ohio SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	030	0		29	10	S5601_030_0	1	1				06/01/2018	2019.01	06/01/2018 06:54:57 PM Eastern Daylight Time		06/01/2018 12:02:30 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	030	0	2019	Indiana, Kentucky SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	031	0		29	10	S5601_031_0	1	1				06/01/2018	2019.01	06/01/2018 07:16:11 PM Eastern Daylight Time		06/01/2018 12:51:34 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	031	0	2019	Indiana, Kentucky SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	032	0		29	10	S5601_032_0	1	1				06/01/2018	2019.01	06/01/2018 06:55:26 PM Eastern Daylight Time		06/01/2018 12:03:56 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	032	0	2019	Wisconsin SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	033	0		29	10	S5601_033_0	1	1				06/02/2018	2019.01	06/02/2018 10:19:14 AM Eastern Daylight Time		06/01/2018 12:53:00 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	033	0	2019	Wisconsin SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	034	0		29	10	S5601_034_0	1	1				06/01/2018	2019.01	06/01/2018 06:55:58 PM Eastern Daylight Time		06/01/2018 12:05:20 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	034	0	2019	Illinois SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	035	0		29	10	S5601_035_0	1	1				06/01/2018	2019.01	06/01/2018 07:16:44 PM Eastern Daylight Time		06/01/2018 12:54:26 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	035	0	2019	Illinois SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	036	0		29	10	S5601_036_0	1	1				06/01/2018	2019.01	06/01/2018 06:56:23 PM Eastern Daylight Time		06/01/2018 12:06:51 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	036	0	2019	Missouri SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	037	0		29	10	S5601_037_0	1	1				06/01/2018	2019.01	06/01/2018 07:17:11 PM Eastern Daylight Time		06/01/2018 12:55:57 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	037	0	2019	Missouri SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	038	0		29	10	S5601_038_0	1	1				06/01/2018	2019.01	06/01/2018 06:56:53 PM Eastern Daylight Time		06/01/2018 12:08:18 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	038	0	2019	Arkansas SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	040	0		29	10	S5601_040_0	1	1				06/01/2018	2019.01	06/01/2018 06:57:20 PM Eastern Daylight Time		06/01/2018 12:09:47 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	040	0	2019	Mississippi SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	041	0		29	10	S5601_041_0	1	1				06/01/2018	2019.01	06/01/2018 07:18:17 PM Eastern Daylight Time		06/01/2018 12:58:57 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	041	0	2019	Mississippi SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	042	0		29	10	S5601_042_0	1	1				06/01/2018	2019.01	06/01/2018 06:57:47 PM Eastern Daylight Time		06/01/2018 12:11:11 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	042	0	2019	Louisiana SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	044	0		29	10	S5601_044_0	1	1				06/01/2018	2019.01	06/01/2018 06:58:17 PM Eastern Daylight Time		06/01/2018 04:50:22 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	044	0	2019	Texas SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	045	0		29	10	S5601_045_0	1	1				06/01/2018	2019.01	06/01/2018 07:19:26 PM Eastern Daylight Time		06/01/2018 01:02:01 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	045	0	2019	Texas SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	046	0		29	10	S5601_046_0	1	1				06/01/2018	2019.01	06/01/2018 06:58:43 PM Eastern Daylight Time		06/01/2018 12:14:08 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	046	0	2019	Oklahoma SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	048	0		29	10	S5601_048_0	1	1				06/01/2018	2019.01	06/01/2018 06:59:18 PM Eastern Daylight Time		06/01/2018 12:15:34 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	048	0	2019	Kansas SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	049	0		29	10	S5601_049_0	1	1				06/02/2018	2019.01	06/02/2018 10:21:07 AM Eastern Daylight Time		06/01/2018 01:05:03 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	049	0	2019	Kansas SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	050	0		29	10	S5601_050_0	1	1				06/01/2018	2019.01	06/01/2018 06:59:46 PM Eastern Daylight Time		06/01/2018 12:16:58 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	050	0	2019	Upper Midwest and N. Plains SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	051	0		29	10	S5601_051_0	1	1				06/01/2018	2019.01	06/01/2018 07:20:25 PM Eastern Daylight Time		06/01/2018 01:06:31 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	051	0	2019	Upper Midwest and N. Plains SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	052	0		29	10	S5601_052_0	1	1				06/01/2018	2019.01	06/01/2018 07:00:14 PM Eastern Daylight Time		06/01/2018 12:18:36 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	052	0	2019	New Mexico SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	053	0		29	10	S5601_053_0	1	1				06/02/2018	2019.01	06/02/2018 10:21:49 AM Eastern Daylight Time		06/01/2018 01:08:03 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	053	0	2019	New Mexico SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	054	0		29	10	S5601_054_0	1	1				06/01/2018	2019.01	06/01/2018 07:00:51 PM Eastern Daylight Time		06/01/2018 04:51:47 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	054	0	2019	Colorado SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	055	0		29	10	S5601_055_0	1	1				06/02/2018	2019.01	06/02/2018 10:22:37 AM Eastern Daylight Time		06/01/2018 01:09:33 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	055	0	2019	Colorado SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	056	0		29	10	S5601_056_0	1	1				06/01/2018	2019.01	06/01/2018 07:01:25 PM Eastern Daylight Time		06/01/2018 04:53:16 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	056	0	2019	Arizona SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	057	0		29	10	S5601_057_0	1	1				06/02/2018	2019.01	06/02/2018 10:23:22 AM Eastern Daylight Time		06/01/2018 01:10:57 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	057	0	2019	Arizona SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	058	0		29	10	S5601_058_0	2	1				06/01/2018	2019.01	06/01/2018 07:01:55 PM Eastern Daylight Time		06/03/2018 10:23:42 AM Eastern Daylight Time			06/03/2018 12:49:47 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	058	0	2019	Nevada SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	059	0		29	10	S5601_059_0	1	1				06/02/2018	2019.01	06/02/2018 10:24:01 AM Eastern Daylight Time		06/01/2018 01:12:31 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	059	0	2019	Nevada SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	060	0		29	10	S5601_060_0	1	1				06/01/2018	2019.01	06/01/2018 07:02:22 PM Eastern Daylight Time		06/01/2018 12:24:24 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	060	0	2019	Oregon, Washington SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	061	0		29	10	S5601_061_0	1	1				06/01/2018	2019.01	06/01/2018 07:21:15 PM Eastern Daylight Time		06/01/2018 01:13:59 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	061	0	2019	Oregon, Washington SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	062	0		29	10	S5601_062_0	1	1				06/01/2018	2019.01	06/01/2018 07:02:51 PM Eastern Daylight Time		06/01/2018 12:25:49 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	062	0	2019	Idaho, Utah SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	063	0		29	10	S5601_063_0	1	1				06/02/2018	2019.01	06/02/2018 10:24:36 AM Eastern Daylight Time		06/01/2018 01:15:26 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	063	0	2019	Idaho, Utah SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	064	0		29	10	S5601_064_0	1	1				06/01/2018	2019.01	06/01/2018 07:03:25 PM Eastern Daylight Time		06/01/2018 12:27:14 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	064	0	2019	California SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	065	0		29	10	S5601_065_0	1	1				06/01/2018	2019.01	06/01/2018 07:21:55 PM Eastern Daylight Time		06/01/2018 01:16:51 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	065	0	2019	California SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	066	0		29	10	S5601_066_0	1	1				06/01/2018	2019.01	06/01/2018 07:04:01 PM Eastern Daylight Time		06/01/2018 12:28:46 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	066	0	2019	Hawaii SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	067	0		29	10	S5601_067_0	1	1				06/02/2018	2019.01	06/02/2018 10:25:19 AM Eastern Daylight Time		06/01/2018 01:18:20 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	067	0	2019	Hawaii SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	068	0		29	10	S5601_068_0	1	1				06/02/2018	2019.01	06/02/2018 11:11:26 AM Eastern Daylight Time		06/01/2018 04:54:49 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Choice (PDP)	10	29					S5601	068	0	2019	Alaska SilverScript Choice		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	107	0		29	10	S5601_107_0	1	1				06/01/2018	2019.01	06/01/2018 07:17:47 PM Eastern Daylight Time		06/01/2018 12:57:25 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	107	0	2019	Arkansas SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	108	0		29	10	S5601_108_0	1	1				06/01/2018	2019.01	06/01/2018 07:18:50 PM Eastern Daylight Time		06/01/2018 01:00:37 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	108	0	2019	Louisiana SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	109	0		29	10	S5601_109_0	1	1				06/02/2018	2019.01	06/02/2018 10:20:06 AM Eastern Daylight Time		06/01/2018 01:03:31 PM Eastern Daylight Time			06/02/2018 02:36:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Plus (PDP)	10	29					S5601	109	0	2019	Oklahoma SilverScript Plus		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	143	0		29	10	S5601_143_0	3	1				06/02/2018	2019.01	06/02/2018 01:31:47 PM Eastern Daylight Time		06/04/2018 11:19:37 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	143	0	2019	Northern New England SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	144	0		29	10	S5601_144_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:22 PM Eastern Daylight Time		06/04/2018 11:20:41 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	144	0	2019	Central New England SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	145	0		29	10	S5601_145_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:22 PM Eastern Daylight Time		06/04/2018 11:21:52 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	145	0	2019	New York SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	146	0		29	10	S5601_146_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:22 PM Eastern Daylight Time		06/04/2018 11:22:58 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	146	0	2019	New Jersey SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	147	0		29	10	S5601_147_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:22 PM Eastern Daylight Time		06/04/2018 11:24:06 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	147	0	2019	Mid-Atlantic SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	148	0		29	10	S5601_148_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:22 PM Eastern Daylight Time		06/04/2018 11:25:20 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	148	0	2019	Pennsylvania, West Virginia SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	149	0		29	10	S5601_149_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:26:31 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	149	0	2019	Virginia SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	150	0		29	10	S5601_150_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:27:50 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	150	0	2019	North Carolina SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	151	0		29	10	S5601_151_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:29:20 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	151	0	2019	South Carolina SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	152	0		29	10	S5601_152_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:30:43 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	152	0	2019	Georgia SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	153	0		29	10	S5601_153_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:32:20 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	153	0	2019	Florida SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	154	0		29	10	S5601_154_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:35:06 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	154	0	2019	Alabama, Tennessee SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	155	0		29	10	S5601_155_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:36:50 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	155	0	2019	Michigan SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	156	0		29	10	S5601_156_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:23 PM Eastern Daylight Time		06/04/2018 11:38:40 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	156	0	2019	Ohio SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	157	0		29	10	S5601_157_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:39:38 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	157	0	2019	Indiana, Kentucky SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	158	0		29	10	S5601_158_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:41:14 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	158	0	2019	Wisconsin SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	159	0		29	10	S5601_159_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:42:12 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	159	0	2019	Illinois SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	160	0		29	10	S5601_160_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:43:24 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	160	0	2019	Missouri SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	161	0		29	10	S5601_161_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:44:42 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	161	0	2019	Arkansas SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	162	0		29	10	S5601_162_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:46:35 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	162	0	2019	Mississippi SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	163	0		29	10	S5601_163_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:48:22 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	163	0	2019	Louisiana SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	164	0		29	10	S5601_164_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:24 PM Eastern Daylight Time		06/04/2018 11:49:45 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	164	0	2019	Texas SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	165	0		29	10	S5601_165_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 11:51:04 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	165	0	2019	Oklahoma SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	166	0		29	10	S5601_166_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 11:52:31 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	166	0	2019	Kansas SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	167	0		29	10	S5601_167_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 11:53:38 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	167	0	2019	Upper Midwest and N. Plains SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	168	0		29	10	S5601_168_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 11:55:22 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	168	0	2019	New Mexico SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	169	0		29	10	S5601_169_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 11:56:30 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	169	0	2019	Colorado SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	170	0		29	10	S5601_170_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 11:57:26 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	170	0	2019	Arizona SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	171	0		29	10	S5601_171_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 11:58:26 AM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	171	0	2019	Nevada SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	172	0		29	10	S5601_172_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:25 PM Eastern Daylight Time		06/04/2018 12:01:22 PM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	172	0	2019	Oregon, Washington SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	173	0		29	10	S5601_173_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:26 PM Eastern Daylight Time		06/04/2018 12:02:25 PM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	173	0	2019	Idaho, Utah SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	174	0		29	10	S5601_174_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:26 PM Eastern Daylight Time		06/04/2018 12:03:39 PM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	174	0	2019	California SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	175	0		29	10	S5601_175_0	3	1				06/02/2018	2019.01	06/02/2018 01:32:56 PM Eastern Daylight Time		06/04/2018 12:04:28 PM Eastern Daylight Time			06/04/2018 03:19:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Allure (PDP)	10	29					S5601	175	0	2019	Hawaii SilverScript Allure		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	801	0		29	10	S5601_801_0	1	1				05/31/2018	2019.01	05/31/2018 02:46:31 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	801	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	802	0		29	10	S5601_802_0	1	1				05/31/2018	2019.01	05/31/2018 02:46:37 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Non-Calendar (PDP)	10	29					S5601	802	0	2019	National SilverScript Group - Non-Calendar		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	803	0		29	10	S5601_803_0	1	1				05/31/2018	2019.01	05/31/2018 02:46:42 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript FI Group - 5 Tier - Calendar (PDP)	10	29					S5601	803	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	804	0		29	10	S5601_804_0	1	1				05/31/2018	2019.01	05/31/2018 02:46:47 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript FI Group - 5 Tier - Calendar (PDP)	10	29					S5601	804	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	805	0		29	10	S5601_805_0	1	1				05/31/2018	2019.01	05/31/2018 02:46:54 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	805	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	806	0		29	10	S5601_806_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:01 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	806	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	807	0		29	10	S5601_807_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:07 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	807	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	808	0		29	10	S5601_808_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:12 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Non Calendar (PDP)	10	29					S5601	808	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	809	0		29	10	S5601_809_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:17 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	809	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	810	0		29	10	S5601_810_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:23 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Non Calendar (PDP)	10	29					S5601	810	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	811	0		29	10	S5601_811_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:28 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - State of NY (PDP)	10	29					S5601	811	0	2019	National		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	812	0		29	10	S5601_812_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:33 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	812	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	813	0		29	10	S5601_813_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:38 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	813	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	814	0		29	10	S5601_814_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:43 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	814	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	815	0		29	10	S5601_815_0	1	1				05/31/2018	2019.01	05/31/2018 02:47:47 PM Eastern Daylight Time					05/31/2018 02:48:15 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	815	0	2019	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5609	001	0		29	10	S5609_001_0	7	1				07/02/2018	2019.01	07/02/2018 12:44:19 PM Mountain Daylight Time		05/31/2018 03:27:58 PM Mountain Daylight Time			07/03/2018 12:24:27 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Basic (PDP)	10	29					S5609	001	0	2019	Region of Oregon and Washington		2					2						www.asuris.com/medicare	www.asuris.com/medicare										(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-																
S5609	002	0		29	10	S5609_002_0	7	1				07/02/2018	2019.01	07/02/2018 12:45:25 PM Mountain Daylight Time		05/31/2018 03:28:34 PM Mountain Daylight Time			07/03/2018 12:24:27 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Enhanced (PDP)	10	29					S5609	002	0	2019	Region of Oregon and Washington		2					2						www.asuris.com/medicare	www.asuris.com/medicare										(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-																
S5609	802	0		29	10	S5609_802_0	1	1				05/08/2018	2019.01	05/08/2018 10:55:50 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script (PDP)	10	29					S5609	802	0	2019	Nationwide except territories		1					2						www.asuris.com/medicare	www.asuris.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5609	804	0		29	10	S5609_804_0	1	1				05/11/2018	2019.01	05/11/2018 01:07:57 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 02 (PDP)	10	29					S5609	804	0	2019	Nationwide except Territories		1					2						www.asuris.com/medicare	www.asuris.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5609	805	0		29	10	S5609_805_0	1	1				05/11/2018	2019.01	05/11/2018 01:08:09 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 03 (PDP)	10	29					S5609	805	0	2019	Nationwide except Territories		1					2						www.asuris.com/medicare	www.asuris.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5617	003	0		29	10	S5617_003_0	6	1				05/24/2018	2019.01	05/24/2018 10:34:12 AM Central Daylight Time		07/16/2018 01:24:38 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	003	0	2019	New Hampshire and Maine		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	008	0		29	10	S5617_008_0	5	1				05/24/2018	2019.01	05/24/2018 10:37:45 AM Central Daylight Time		07/16/2018 01:25:52 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	008	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	013	0		29	10	S5617_013_0	5	1				05/24/2018	2019.01	05/24/2018 10:46:32 AM Central Daylight Time		07/16/2018 01:26:58 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	013	0	2019	New York		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	018	0		29	10	S5617_018_0	5	1				05/24/2018	2019.01	05/24/2018 10:46:07 AM Central Daylight Time		07/16/2018 01:28:08 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	018	0	2019	New Jersey		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	053	0		29	10	S5617_053_0	5	1				05/24/2018	2019.01	05/24/2018 09:58:10 PM Central Daylight Time		07/16/2018 01:29:16 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	053	0	2019	Florida		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	068	0		29	10	S5617_068_0	5	1				05/24/2018	2019.01	05/24/2018 10:52:25 AM Central Daylight Time		07/16/2018 01:30:24 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	068	0	2019	Ohio		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	088	0		29	10	S5617_088_0	5	1				05/24/2018	2019.01	05/24/2018 09:59:53 PM Central Daylight Time		07/16/2018 01:31:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	088	0	2019	Missouri		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	103	0		29	10	S5617_103_0	5	1				05/24/2018	2019.01	05/24/2018 10:32:28 AM Central Daylight Time		07/16/2018 01:32:42 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	103	0	2019	Louisiana		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	108	0		29	10	S5617_108_0	4	1				05/24/2018	2019.01	05/24/2018 10:54:55 AM Central Daylight Time		07/16/2018 01:33:52 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	108	0	2019	Texas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	113	0		29	10	S5617_113_0	4	1				05/24/2018	2019.01	05/24/2018 10:55:37 AM Central Daylight Time		07/16/2018 01:35:00 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	113	0	2019	Oklahoma		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	118	0		29	10	S5617_118_0	4	1				05/24/2018	2019.01	05/24/2018 10:58:04 AM Central Daylight Time		07/16/2018 01:36:10 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	118	0	2019	Kansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	123	0		29	10	S5617_123_0	4	1				05/24/2018	2019.01	05/24/2018 10:04:06 PM Central Daylight Time		07/16/2018 01:37:18 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	123	0	2019	IA, MN, MT, ND, NE, SD, WY		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	128	0		29	10	S5617_128_0	4	1				05/24/2018	2019.01	05/24/2018 11:02:37 AM Central Daylight Time		07/16/2018 01:38:26 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	128	0	2019	New Mexico		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	133	0		29	10	S5617_133_0	4	1				05/24/2018	2019.01	05/24/2018 11:05:06 AM Central Daylight Time		07/16/2018 01:39:38 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	133	0	2019	Colorado		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	138	0		29	10	S5617_138_0	4	1				05/24/2018	2019.01	05/24/2018 11:06:02 AM Central Daylight Time		07/16/2018 01:40:52 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	138	0	2019	Arizona		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	143	0		29	10	S5617_143_0	4	1				05/24/2018	2019.01	05/24/2018 11:07:07 AM Central Daylight Time		07/16/2018 01:42:02 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	143	0	2019	Nevada		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	148	0		29	10	S5617_148_0	4	1				05/24/2018	2019.01	05/24/2018 11:08:11 AM Central Daylight Time		07/16/2018 01:43:10 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	148	0	2019	Oregon and Washington		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	153	0		29	10	S5617_153_0	4	1				05/24/2018	2019.01	05/24/2018 11:09:02 AM Central Daylight Time		07/16/2018 01:44:18 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	153	0	2019	Idaho and Utah		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	158	0		29	10	S5617_158_0	4	1				05/24/2018	2019.01	05/24/2018 11:09:54 AM Central Daylight Time		07/16/2018 01:45:26 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	158	0	2019	California		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	163	0		29	10	S5617_163_0	4	1				05/24/2018	2019.01	05/24/2018 10:01:29 PM Central Daylight Time		07/16/2018 01:46:34 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	163	0	2019	Hawaii		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	214	0		29	10	S5617_214_0	4	1				05/24/2018	2019.01	05/24/2018 11:11:39 AM Central Daylight Time		07/16/2018 01:47:42 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	214	0	2019	Delaware, Maryland and District of Columbia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	215	0		29	10	S5617_215_0	4	1				05/24/2018	2019.01	05/24/2018 11:12:31 AM Central Daylight Time		07/16/2018 01:48:50 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	215	0	2019	Pennsylvania and West Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	216	0		29	10	S5617_216_0	4	1				05/24/2018	2019.01	05/24/2018 11:13:46 AM Central Daylight Time		07/16/2018 01:50:02 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	216	0	2019	Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	217	0		29	10	S5617_217_0	4	1				05/24/2018	2019.01	05/24/2018 11:15:36 AM Central Daylight Time		07/16/2018 01:51:10 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	217	0	2019	North Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	218	0		29	10	S5617_218_0	4	1				05/24/2018	2019.01	05/24/2018 11:21:07 AM Central Daylight Time		07/16/2018 01:52:18 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	218	0	2019	South Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	219	0		29	10	S5617_219_0	4	1				05/24/2018	2019.01	05/24/2018 11:22:50 AM Central Daylight Time		07/16/2018 01:53:28 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	219	0	2019	Georgia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	220	0		29	10	S5617_220_0	4	1				05/24/2018	2019.01	05/24/2018 11:26:03 AM Central Daylight Time		07/16/2018 01:54:38 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	220	0	2019	Alabama and Tennessee		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	221	0		29	10	S5617_221_0	4	1				05/24/2018	2019.01	05/24/2018 11:26:59 AM Central Daylight Time		07/16/2018 01:55:48 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	221	0	2019	Michigan		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	222	0		29	10	S5617_222_0	4	1				05/24/2018	2019.01	05/24/2018 11:27:42 AM Central Daylight Time		07/16/2018 01:56:56 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	222	0	2019	Indiana and Kentucky		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	223	0		29	10	S5617_223_0	4	1				05/24/2018	2019.01	05/24/2018 11:28:28 AM Central Daylight Time		07/16/2018 01:58:06 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	223	0	2019	Wisconsin		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	224	0		29	10	S5617_224_0	4	1				05/24/2018	2019.01	05/24/2018 11:29:05 AM Central Daylight Time		07/16/2018 01:59:16 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	224	0	2019	Illinois		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	225	0		29	10	S5617_225_0	4	1				05/24/2018	2019.01	05/24/2018 11:30:51 AM Central Daylight Time		07/16/2018 02:00:26 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	225	0	2019	Arkansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	226	0		29	10	S5617_226_0	4	1				05/24/2018	2019.01	05/24/2018 11:34:08 AM Central Daylight Time		07/16/2018 02:01:36 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	226	0	2019	Mississippi		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	227	0		29	10	S5617_227_0	4	1				05/24/2018	2019.01	05/24/2018 11:36:22 AM Central Daylight Time		07/16/2018 02:02:46 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	227	0	2019	Alaska		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	246	0		29	10	S5617_246_0	5	1				05/28/2018	2019.01	05/28/2018 05:19:27 PM Central Daylight Time		07/16/2018 02:03:54 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	246	0	2019	New Hampshire and Maine		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	247	0		29	10	S5617_247_0	4	1				05/28/2018	2019.01	05/28/2018 05:19:43 PM Central Daylight Time		07/16/2018 02:05:04 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	247	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	248	0		29	10	S5617_248_0	4	1				05/28/2018	2019.01	05/28/2018 05:20:02 PM Central Daylight Time		07/16/2018 02:06:14 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	248	0	2019	New York		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	249	0		29	10	S5617_249_0	4	1				05/28/2018	2019.01	05/28/2018 05:20:20 PM Central Daylight Time		07/16/2018 02:07:22 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	249	0	2019	New Jersey		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	250	0		29	10	S5617_250_0	4	1				05/28/2018	2019.01	05/28/2018 05:20:41 PM Central Daylight Time		07/16/2018 02:08:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	250	0	2019	Delaware, Maryland and District of Columbia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	251	0		29	10	S5617_251_0	4	1				05/28/2018	2019.01	05/28/2018 05:20:59 PM Central Daylight Time		07/16/2018 02:09:40 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	251	0	2019	Pennsylvania and West Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	252	0		29	10	S5617_252_0	4	1				05/28/2018	2019.01	05/28/2018 05:21:15 PM Central Daylight Time		07/16/2018 02:10:50 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	252	0	2019	Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	253	0		29	10	S5617_253_0	4	1				05/28/2018	2019.01	05/28/2018 05:21:40 PM Central Daylight Time		07/16/2018 02:11:58 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	253	0	2019	North Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	254	0		29	10	S5617_254_0	4	1				05/28/2018	2019.01	05/28/2018 05:21:58 PM Central Daylight Time		07/16/2018 02:13:06 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	254	0	2019	South Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	255	0		29	10	S5617_255_0	4	1				05/29/2018	2019.01	05/29/2018 09:49:24 PM Central Daylight Time		07/16/2018 02:14:16 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	255	0	2019	Georgia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	256	0		29	10	S5617_256_0	4	1				05/28/2018	2019.01	05/28/2018 05:22:35 PM Central Daylight Time		07/16/2018 02:15:24 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	256	0	2019	Florida		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	257	0		29	10	S5617_257_0	4	1				05/28/2018	2019.01	05/28/2018 05:22:54 PM Central Daylight Time		07/16/2018 02:16:34 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	257	0	2019	Alabama and Tennessee		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	258	0		29	10	S5617_258_0	4	1				05/28/2018	2019.01	05/28/2018 05:23:14 PM Central Daylight Time		07/16/2018 02:17:42 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	258	0	2019	Michigan		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	259	0		29	10	S5617_259_0	4	1				05/28/2018	2019.01	05/28/2018 05:23:32 PM Central Daylight Time		07/16/2018 02:18:52 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	259	0	2019	Ohio		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	260	0		29	10	S5617_260_0	4	1				05/28/2018	2019.01	05/28/2018 05:23:51 PM Central Daylight Time		07/16/2018 02:20:02 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	260	0	2019	Indiana and Kentucky		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	261	0		29	10	S5617_261_0	4	1				05/28/2018	2019.01	05/28/2018 05:24:13 PM Central Daylight Time		07/16/2018 02:21:10 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	261	0	2019	Wisconsin		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	262	0		29	10	S5617_262_0	4	1				05/28/2018	2019.01	05/28/2018 05:24:31 PM Central Daylight Time		07/16/2018 02:22:20 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	262	0	2019	Illinois		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	263	0		29	10	S5617_263_0	4	1				05/28/2018	2019.01	05/28/2018 05:24:47 PM Central Daylight Time		07/16/2018 02:23:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	263	0	2019	Missouri		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	264	0		29	10	S5617_264_0	4	1				05/28/2018	2019.01	05/28/2018 05:25:06 PM Central Daylight Time		07/16/2018 02:24:40 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	264	0	2019	Arkansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	265	0		29	10	S5617_265_0	4	1				05/28/2018	2019.01	05/28/2018 05:25:24 PM Central Daylight Time		07/16/2018 02:25:54 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	265	0	2019	Mississippi		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	266	0		29	10	S5617_266_0	4	1				05/28/2018	2019.01	05/28/2018 05:25:42 PM Central Daylight Time		07/16/2018 02:27:04 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	266	0	2019	Louisiana		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	267	0		29	10	S5617_267_0	4	1				05/28/2018	2019.01	05/28/2018 05:26:01 PM Central Daylight Time		07/16/2018 02:28:14 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	267	0	2019	Texas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	268	0		29	10	S5617_268_0	5	1				06/27/2018	2019.01	06/27/2018 03:26:52 PM Central Daylight Time		07/16/2018 02:29:22 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	268	0	2019	Oklahoma		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	269	0		29	10	S5617_269_0	4	1				05/28/2018	2019.01	05/28/2018 05:26:36 PM Central Daylight Time		07/16/2018 02:30:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	269	0	2019	Kansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	270	0		29	10	S5617_270_0	4	1				05/28/2018	2019.01	05/28/2018 05:26:55 PM Central Daylight Time		07/16/2018 02:31:42 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	270	0	2019	IA, MN, MT, ND, NE, SD, WY		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	271	0		29	10	S5617_271_0	4	1				05/28/2018	2019.01	05/28/2018 05:27:12 PM Central Daylight Time		07/16/2018 02:32:52 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	271	0	2019	New Mexico		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	272	0		29	10	S5617_272_0	4	1				05/28/2018	2019.01	05/28/2018 05:27:29 PM Central Daylight Time		07/16/2018 02:34:00 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	272	0	2019	Colorado		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	273	0		29	10	S5617_273_0	4	1				05/28/2018	2019.01	05/28/2018 05:27:47 PM Central Daylight Time		07/16/2018 02:35:12 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	273	0	2019	Arizona		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	274	0		29	10	S5617_274_0	4	1				05/28/2018	2019.01	05/28/2018 05:28:03 PM Central Daylight Time		07/16/2018 02:36:20 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	274	0	2019	Nevada		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	275	0		29	10	S5617_275_0	4	1				05/28/2018	2019.01	05/28/2018 05:28:21 PM Central Daylight Time		07/16/2018 02:37:30 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	275	0	2019	Oregon and Washington		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	276	0		29	10	S5617_276_0	4	1				05/28/2018	2019.01	05/28/2018 05:28:38 PM Central Daylight Time		07/16/2018 02:38:40 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	276	0	2019	Idaho and Utah		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	277	0		29	10	S5617_277_0	5	1				06/27/2018	2019.01	06/27/2018 03:28:46 PM Central Daylight Time		07/16/2018 02:39:54 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	277	0	2019	California		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	278	0		29	10	S5617_278_0	4	1				05/28/2018	2019.01	05/28/2018 05:29:14 PM Central Daylight Time		07/16/2018 02:41:02 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	278	0	2019	Hawaii		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	279	0		29	10	S5617_279_0	4	1				05/28/2018	2019.01	05/28/2018 05:29:33 PM Central Daylight Time		07/16/2018 02:42:14 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	279	0	2019	Alaska		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	280	0		29	10	S5617_280_0	5	1				05/24/2018	2019.01	05/24/2018 01:02:16 PM Central Daylight Time		07/16/2018 04:00:16 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	280	0	2019	New Hampshire and Maine		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	281	0		29	10	S5617_281_0	5	1				06/27/2018	2019.01	06/27/2018 03:49:23 PM Central Daylight Time		07/16/2018 03:02:50 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	281	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	282	0		29	10	S5617_282_0	5	1				06/27/2018	2019.01	06/27/2018 03:49:58 PM Central Daylight Time		07/16/2018 03:03:58 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	282	0	2019	New York		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	283	0		29	10	S5617_283_0	5	1				06/27/2018	2019.01	06/27/2018 03:50:41 PM Central Daylight Time		07/16/2018 03:05:10 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	283	0	2019	New Jersey		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	284	0		29	10	S5617_284_0	4	1				05/24/2018	2019.01	05/24/2018 03:14:37 PM Central Daylight Time		07/16/2018 03:06:22 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	284	0	2019	Delaware, Maryland and District of Columbia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	285	0		29	10	S5617_285_0	5	1				06/27/2018	2019.01	06/27/2018 03:51:08 PM Central Daylight Time		07/16/2018 03:07:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	285	0	2019	Pennsylvania and West Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	286	0		29	10	S5617_286_0	4	1				05/24/2018	2019.01	05/24/2018 03:16:16 PM Central Daylight Time		07/16/2018 03:08:40 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	286	0	2019	Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	287	0		29	10	S5617_287_0	5	1				06/27/2018	2019.01	06/27/2018 03:51:37 PM Central Daylight Time		07/16/2018 03:09:50 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	287	0	2019	North Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	288	0		29	10	S5617_288_0	4	1				05/24/2018	2019.01	05/24/2018 03:17:08 PM Central Daylight Time		07/16/2018 03:10:58 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	288	0	2019	South Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	289	0		29	10	S5617_289_0	4	1				05/24/2018	2019.01	05/24/2018 01:20:45 PM Central Daylight Time		07/16/2018 03:12:08 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	289	0	2019	Georgia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	290	0		29	10	S5617_290_0	5	1				06/27/2018	2019.01	06/27/2018 03:52:24 PM Central Daylight Time		07/16/2018 03:13:16 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	290	0	2019	Florida		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	291	0		29	10	S5617_291_0	5	1				06/27/2018	2019.01	06/27/2018 03:53:11 PM Central Daylight Time		07/16/2018 03:14:24 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	291	0	2019	Alabama and Tennessee		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	292	0		29	10	S5617_292_0	5	1				06/27/2018	2019.01	06/27/2018 03:53:54 PM Central Daylight Time		07/16/2018 03:15:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	292	0	2019	Michigan		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	293	0		29	10	S5617_293_0	5	1				06/27/2018	2019.01	06/27/2018 03:54:52 PM Central Daylight Time		07/16/2018 03:16:50 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	293	0	2019	Ohio		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	294	0		29	10	S5617_294_0	5	1				06/27/2018	2019.01	06/27/2018 03:56:10 PM Central Daylight Time		07/16/2018 03:17:58 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	294	0	2019	Indiana and Kentucky		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	295	0		29	10	S5617_295_0	5	1				06/27/2018	2019.01	06/27/2018 03:57:04 PM Central Daylight Time		07/16/2018 03:19:06 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	295	0	2019	Wisconsin		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	296	0		29	10	S5617_296_0	5	1				06/27/2018	2019.01	06/27/2018 03:58:12 PM Central Daylight Time		07/16/2018 03:20:16 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	296	0	2019	Illinois		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	297	0		29	10	S5617_297_0	5	1				06/27/2018	2019.01	06/27/2018 03:59:12 PM Central Daylight Time		07/16/2018 03:21:24 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	297	0	2019	Missouri		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	298	0		29	10	S5617_298_0	4	1				05/24/2018	2019.01	05/24/2018 02:57:30 PM Central Daylight Time		07/16/2018 03:22:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	298	0	2019	Arkansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	299	0		29	10	S5617_299_0	4	1				05/24/2018	2019.01	05/24/2018 03:05:08 PM Central Daylight Time		07/16/2018 03:23:52 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	299	0	2019	Mississippi		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	300	0		29	10	S5617_300_0	5	1				06/27/2018	2019.01	06/27/2018 04:00:22 PM Central Daylight Time		07/16/2018 03:25:00 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	300	0	2019	Louisiana		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	301	0		29	10	S5617_301_0	4	1				05/24/2018	2019.01	05/24/2018 03:18:37 PM Central Daylight Time		07/16/2018 04:02:06 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	301	0	2019	Texas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	302	0		29	10	S5617_302_0	5	1				06/27/2018	2019.01	06/27/2018 04:01:33 PM Central Daylight Time		07/16/2018 03:37:28 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	302	0	2019	Oklahoma		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	303	0		29	10	S5617_303_0	4	1				05/25/2018	2019.01	05/25/2018 08:19:11 AM Central Daylight Time		07/16/2018 04:03:44 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	303	0	2019	Kansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	304	0		29	10	S5617_304_0	5	1				06/27/2018	2019.01	06/27/2018 04:02:41 PM Central Daylight Time		07/16/2018 03:40:32 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	304	0	2019	IA, MN, MT, ND, SD, NE, WY		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	305	0		29	10	S5617_305_0	4	1				05/24/2018	2019.01	05/24/2018 03:19:19 PM Central Daylight Time		07/16/2018 03:41:42 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	305	0	2019	New Mexico		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	306	0		29	10	S5617_306_0	4	1				05/24/2018	2019.01	05/24/2018 03:20:03 PM Central Daylight Time		07/16/2018 03:42:54 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	306	0	2019	Colorado		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	307	0		29	10	S5617_307_0	4	1				05/24/2018	2019.01	05/24/2018 03:20:42 PM Central Daylight Time		07/16/2018 03:44:10 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	307	0	2019	Arizona		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	308	0		29	10	S5617_308_0	5	1				06/27/2018	2019.01	06/27/2018 04:03:40 PM Central Daylight Time		07/16/2018 03:45:20 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	308	0	2019	Nevada		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	309	0		29	10	S5617_309_0	4	1				05/24/2018	2019.01	05/24/2018 03:21:24 PM Central Daylight Time		07/16/2018 03:46:28 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	309	0	2019	Oregon and Washington		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	310	0		29	10	S5617_310_0	5	1				06/27/2018	2019.01	06/27/2018 04:04:35 PM Central Daylight Time		07/16/2018 03:47:38 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	310	0	2019	Idaho and Utah		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	311	0		29	10	S5617_311_0	5	1				06/27/2018	2019.01	06/27/2018 04:05:31 PM Central Daylight Time		07/16/2018 03:48:50 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	311	0	2019	California		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	312	0		29	10	S5617_312_0	5	1				06/27/2018	2019.01	06/27/2018 04:06:39 PM Central Daylight Time		07/16/2018 03:50:00 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	312	0	2019	Hawaii		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	313	0		29	10	S5617_313_0	5	1				06/27/2018	2019.01	06/27/2018 04:07:36 PM Central Daylight Time		07/16/2018 03:51:10 PM Central Daylight Time			07/19/2018 09:58:32 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	313	0	2019	Alaska		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	801	0		29	10	S5617_801_0	3	1				05/24/2018	2019.01	05/24/2018 03:55:27 PM Central Daylight Time					05/31/2018 10:31:48 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan CY (PDP)	10	29					S5617	801	0	2019	Nationwide		1					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5617	802	0		29	10	S5617_802_0	3	1				05/24/2018	2019.01	05/24/2018 03:55:35 PM Central Daylight Time					05/31/2018 10:31:48 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan NCY (PDP)	10	29					S5617	802	0	2019	Nationwide		1					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5617	805	0		29	10	S5617_805_0	3	1				05/24/2018	2019.01	05/24/2018 03:55:41 PM Central Daylight Time					05/31/2018 10:31:48 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan CY (PDP)	10	29					S5617	805	0	2019	Nationwide		1					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5617	806	0		29	10	S5617_806_0	3	1				05/24/2018	2019.01	05/24/2018 03:55:47 PM Central Daylight Time					05/31/2018 10:31:48 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan NCY (PDP)	10	29					S5617	806	0	2019	Nationwide		1					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5660	104	0		29	10	S5660_104_0	1	1				06/01/2018	2019.01	06/01/2018 02:23:47 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	104	0	2019	Northern New England		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	105	0		29	10	S5660_105_0	1	1				05/28/2018	2019.01	05/28/2018 12:42:46 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	105	0	2019	Central New England		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	106	0		29	10	S5660_106_0	2	1				05/28/2018	2019.01	05/28/2018 12:12:45 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	106	0	2019	State of New Jersey		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	107	0		29	10	S5660_107_0	1	1				05/28/2018	2019.01	05/28/2018 12:13:37 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	107	0	2019	Mid-Atlantic		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	108	0		29	10	S5660_108_0	1	1				05/29/2018	2019.01	05/29/2018 03:35:07 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	108	0	2019	States of Pennsylvania and West Virginia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	109	0		29	10	S5660_109_0	1	1				05/28/2018	2019.01	05/28/2018 12:14:39 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	109	0	2019	State of Virginia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	110	0		29	10	S5660_110_0	1	1				05/28/2018	2019.01	05/28/2018 12:15:50 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	110	0	2019	State of North Carolina		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	111	0		29	10	S5660_111_0	1	1				05/28/2018	2019.01	05/28/2018 12:17:10 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	111	0	2019	State of South Carolina		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	112	0		29	10	S5660_112_0	1	1				05/28/2018	2019.01	05/28/2018 12:18:09 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	112	0	2019	State of Georgia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	113	0		29	10	S5660_113_0	1	1				05/28/2018	2019.01	05/28/2018 12:19:02 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	113	0	2019	State of Florida		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	114	0		29	10	S5660_114_0	1	1				05/28/2018	2019.01	05/28/2018 12:20:14 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	114	0	2019	States of Alabama and Tennessee		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	115	0		29	10	S5660_115_0	1	1				05/28/2018	2019.01	05/28/2018 12:21:07 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	115	0	2019	State of Michigan		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	116	0		29	10	S5660_116_0	1	1				05/28/2018	2019.01	05/28/2018 12:21:53 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	116	0	2019	State of Ohio		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	117	0		29	10	S5660_117_0	1	1				05/28/2018	2019.01	05/28/2018 12:43:44 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	117	0	2019	States of Indiana and Kentucky		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	118	0		29	10	S5660_118_0	1	1				05/28/2018	2019.01	05/28/2018 12:22:43 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	118	0	2019	State of Wisconsin		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	119	0		29	10	S5660_119_0	1	1				05/28/2018	2019.01	05/28/2018 12:47:51 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	119	0	2019	State of Illinois		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	120	0		29	10	S5660_120_0	1	1				05/28/2018	2019.01	05/28/2018 12:23:40 PM Eastern Daylight Time		06/04/2018 08:50:05 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	120	0	2019	State of Missouri		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	121	0		29	10	S5660_121_0	1	1				05/28/2018	2019.01	05/28/2018 12:24:34 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	121	0	2019	State of Arkansas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	122	0		29	10	S5660_122_0	1	1				05/28/2018	2019.01	05/28/2018 12:49:52 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	122	0	2019	State of Mississippi		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	123	0		29	10	S5660_123_0	1	1				05/28/2018	2019.01	05/28/2018 12:25:31 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	123	0	2019	State of Louisiana		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	124	0		29	10	S5660_124_0	1	1				05/28/2018	2019.01	05/28/2018 12:26:40 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	124	0	2019	State of Texas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	125	0		29	10	S5660_125_0	1	1				05/28/2018	2019.01	05/28/2018 12:27:47 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	125	0	2019	State of Oklahoma		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	126	0		29	10	S5660_126_0	1	1				05/28/2018	2019.01	05/28/2018 12:51:39 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	126	0	2019	State of Kansas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	127	0		29	10	S5660_127_0	1	1				05/28/2018	2019.01	05/28/2018 12:53:26 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	127	0	2019	Upper Midwest and Northern Plains		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	128	0		29	10	S5660_128_0	1	1				05/28/2018	2019.01	05/28/2018 12:54:41 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	128	0	2019	State of New Mexico		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	129	0		29	10	S5660_129_0	1	1				05/28/2018	2019.01	05/28/2018 12:56:23 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	129	0	2019	State of Colorado		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	130	0		29	10	S5660_130_0	1	1				05/28/2018	2019.01	05/28/2018 12:28:54 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	130	0	2019	State of Arizona		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	131	0		29	10	S5660_131_0	1	1				05/28/2018	2019.01	05/28/2018 12:57:39 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	131	0	2019	State of Nevada		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	132	0		29	10	S5660_132_0	1	1				05/28/2018	2019.01	05/28/2018 12:29:50 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	132	0	2019	States of Oregon and Washington		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	133	0		29	10	S5660_133_0	1	1				05/28/2018	2019.01	05/28/2018 12:30:49 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	133	0	2019	States of Idaho and Utah		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	134	0		29	10	S5660_134_0	1	1				05/28/2018	2019.01	05/28/2018 12:31:35 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	134	0	2019	State of California		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	135	0		29	10	S5660_135_0	1	1				05/28/2018	2019.01	05/28/2018 12:32:21 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	135	0	2019	State of Hawaii		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	136	0		29	10	S5660_136_0	1	1				05/28/2018	2019.01	05/28/2018 12:33:25 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	136	0	2019	State of Alaska		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	137	0		29	10	S5660_137_0	1	1				05/28/2018	2019.01	05/28/2018 12:58:53 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	137	0	2019	Puerto Rico		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	172	0		29	10	S5660_172_0	2	1				07/16/2018	2019.01	07/16/2018 10:39:10 AM Eastern Daylight Time		07/11/2018 01:40:10 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	172	0	2019	Northern New England		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	176	0		29	10	S5660_176_0	2	1				07/16/2018	2019.01	07/16/2018 11:20:00 AM Eastern Daylight Time		07/11/2018 01:40:50 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	176	0	2019	States of Pennsylvania and West Virginia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	180	0		29	10	S5660_180_0	2	1				07/16/2018	2019.01	07/16/2018 11:27:25 AM Eastern Daylight Time		07/11/2018 01:41:32 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	180	0	2019	State of Georgia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	181	0		29	10	S5660_181_0	2	1				07/16/2018	2019.01	07/16/2018 11:30:58 AM Eastern Daylight Time		07/11/2018 01:42:14 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	181	0	2019	State of Florida		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	182	0		29	10	S5660_182_0	2	1				07/16/2018	2019.01	07/16/2018 11:34:19 AM Eastern Daylight Time		07/11/2018 01:42:56 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	182	0	2019	States of Alabama and Tennessee		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	183	0		29	10	S5660_183_0	2	1				07/16/2018	2019.01	07/16/2018 11:38:39 AM Eastern Daylight Time		07/11/2018 01:43:42 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	183	0	2019	State of Michigan		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	184	0		29	10	S5660_184_0	2	1				07/16/2018	2019.01	07/16/2018 11:39:28 AM Eastern Daylight Time		07/11/2018 01:44:24 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	184	0	2019	State of Ohio		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	185	0		29	10	S5660_185_0	2	1				07/16/2018	2019.01	07/16/2018 11:40:15 AM Eastern Daylight Time		07/11/2018 01:45:06 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	185	0	2019	States of Indiana and Kentucky		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	186	0		29	10	S5660_186_0	3	1				07/16/2018	2019.01	07/16/2018 11:42:21 AM Eastern Daylight Time		07/18/2018 09:51:30 AM Eastern Daylight Time			07/18/2018 01:21:35 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	186	0	2019	State of Wisconsin		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	187	0		29	10	S5660_187_0	2	1				07/16/2018	2019.01	07/16/2018 11:43:32 AM Eastern Daylight Time		07/11/2018 01:46:34 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	187	0	2019	State of Illinois		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	190	0		29	10	S5660_190_0	2	1				07/16/2018	2019.01	07/16/2018 11:46:08 AM Eastern Daylight Time		07/11/2018 01:47:18 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	190	0	2019	State of Mississippi		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	192	0		29	10	S5660_192_0	2	1				07/16/2018	2019.01	07/16/2018 11:47:58 AM Eastern Daylight Time		07/11/2018 01:48:00 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	192	0	2019	State of Texas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	194	0		29	10	S5660_194_0	2	1				07/18/2018	2019.01	07/18/2018 09:18:54 AM Eastern Daylight Time		07/11/2018 01:48:42 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	194	0	2019	State of Kansas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	195	0		29	10	S5660_195_0	2	1				07/16/2018	2019.01	07/16/2018 11:50:43 AM Eastern Daylight Time		07/11/2018 01:49:24 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	195	0	2019	Upper Midwest and Northern Plains		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	196	0		29	10	S5660_196_0	2	1				07/16/2018	2019.01	07/16/2018 11:51:29 AM Eastern Daylight Time		07/11/2018 01:50:04 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	196	0	2019	State of New Mexico		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	197	0		29	10	S5660_197_0	2	1				07/16/2018	2019.01	07/16/2018 11:52:26 AM Eastern Daylight Time		07/11/2018 01:50:46 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	197	0	2019	State of Colorado		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	198	0		29	10	S5660_198_0	2	1				07/16/2018	2019.01	07/16/2018 11:53:37 AM Eastern Daylight Time		07/11/2018 01:51:30 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	198	0	2019	State of Arizona		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	199	0		29	10	S5660_199_0	2	1				07/16/2018	2019.01	07/16/2018 11:54:43 AM Eastern Daylight Time		07/11/2018 01:52:12 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	199	0	2019	State of Nevada		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	202	0		29	10	S5660_202_0	2	1				07/16/2018	2019.01	07/16/2018 11:57:21 AM Eastern Daylight Time		07/11/2018 01:52:54 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	202	0	2019	State of California		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	203	0		29	10	S5660_203_0	2	1				07/16/2018	2019.01	07/16/2018 11:58:10 AM Eastern Daylight Time		07/11/2018 01:53:36 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	203	0	2019	State of Hawaii		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	204	0		29	10	S5660_204_0	2	1				07/16/2018	2019.01	07/16/2018 11:58:55 AM Eastern Daylight Time		07/11/2018 01:54:20 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	204	0	2019	State of Alaska		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	206	0		29	10	S5660_206_0	2	1				07/16/2018	2019.01	07/16/2018 10:48:10 AM Eastern Daylight Time		07/11/2018 01:55:02 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	206	0	2019	Central New England		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	207	0		29	10	S5660_207_0	2	1				07/16/2018	2019.01	07/16/2018 11:11:36 AM Eastern Daylight Time		07/11/2018 01:55:48 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	207	0	2019	State of New Jersey		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	208	0		29	10	S5660_208_0	2	1				07/16/2018	2019.01	07/16/2018 11:18:50 AM Eastern Daylight Time		07/11/2018 01:56:30 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	208	0	2019	Mid-Atlantic		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	209	0		29	10	S5660_209_0	2	1				07/16/2018	2019.01	07/16/2018 11:24:31 AM Eastern Daylight Time		07/11/2018 01:57:14 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	209	0	2019	State of North Carolina		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	210	0		29	10	S5660_210_0	2	1				07/16/2018	2019.01	07/16/2018 11:25:57 AM Eastern Daylight Time		07/11/2018 01:57:58 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	210	0	2019	State of South Carolina		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	211	0		29	10	S5660_211_0	2	1				07/16/2018	2019.01	07/16/2018 11:44:21 AM Eastern Daylight Time		07/11/2018 01:58:40 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	211	0	2019	State of Missouri		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	212	0		29	10	S5660_212_0	2	1				07/16/2018	2019.01	07/16/2018 11:45:16 AM Eastern Daylight Time		07/11/2018 01:59:24 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	212	0	2019	State of Arkansas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	213	0		29	10	S5660_213_0	2	1				07/16/2018	2019.01	07/16/2018 11:47:10 AM Eastern Daylight Time		07/11/2018 02:00:04 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	213	0	2019	State of Louisiana		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	214	0		29	10	S5660_214_0	2	1				07/16/2018	2019.01	07/16/2018 11:48:50 AM Eastern Daylight Time		07/11/2018 02:00:48 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	214	0	2019	State of Oklahoma		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	215	0		29	10	S5660_215_0	2	1				07/16/2018	2019.01	07/16/2018 11:55:30 AM Eastern Daylight Time		07/11/2018 02:01:30 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	215	0	2019	States of Oregon and Washington		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	216	0		29	10	S5660_216_0	2	1				07/16/2018	2019.01	07/16/2018 11:56:35 AM Eastern Daylight Time		07/11/2018 02:02:12 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	216	0	2019	States of Idaho and Utah		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	217	0		29	10	S5660_217_0	2	1				07/16/2018	2019.01	07/16/2018 11:21:08 AM Eastern Daylight Time		07/11/2018 02:02:54 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	217	0	2019	State of Virginia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	218	0		29	10	S5660_218_0	1	1				05/28/2018	2019.01	05/28/2018 11:15:12 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	218	0	2019	Northern New England		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	219	0		29	10	S5660_219_0	1	1				05/28/2018	2019.01	05/28/2018 11:55:04 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	219	0	2019	Central New England		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	220	0		29	10	S5660_220_0	1	1				05/28/2018	2019.01	05/28/2018 11:39:23 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	220	0	2019	State of New Jersey		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	221	0		29	10	S5660_221_0	1	1				05/28/2018	2019.01	05/28/2018 11:40:09 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	221	0	2019	Mid-Atlantic		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	222	0		29	10	S5660_222_0	1	1				05/28/2018	2019.01	05/28/2018 11:41:01 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	222	0	2019	States of Pennsylvania and West Virginia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	223	0		29	10	S5660_223_0	1	1				05/28/2018	2019.01	05/28/2018 11:55:50 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	223	0	2019	State of Virginia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	224	0		29	10	S5660_224_0	1	1				05/28/2018	2019.01	05/28/2018 11:15:58 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	224	0	2019	State of North Carolina		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	225	0		29	10	S5660_225_0	1	1				05/28/2018	2019.01	05/28/2018 11:41:46 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	225	0	2019	State of South Carolina		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	226	0		29	10	S5660_226_0	1	1				05/28/2018	2019.01	05/28/2018 11:17:16 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	226	0	2019	State of Georgia		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	227	0		29	10	S5660_227_0	1	1				05/28/2018	2019.01	05/28/2018 11:44:09 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	227	0	2019	State of Florida		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	228	0		29	10	S5660_228_0	1	1				05/28/2018	2019.01	05/28/2018 11:19:14 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	228	0	2019	States of Alabama and Tennessee		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	229	0		29	10	S5660_229_0	1	1				05/28/2018	2019.01	05/28/2018 11:19:56 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	229	0	2019	State of Michigan		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	230	0		29	10	S5660_230_0	1	1				05/28/2018	2019.01	05/28/2018 11:56:33 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	230	0	2019	State of Ohio		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	231	0		29	10	S5660_231_0	1	1				05/28/2018	2019.01	05/28/2018 11:57:17 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	231	0	2019	States of Indiana and Kentucky		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	232	0		29	10	S5660_232_0	1	1				05/28/2018	2019.01	05/28/2018 10:59:21 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	232	0	2019	State of Wisconsin		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	233	0		29	10	S5660_233_0	2	1				05/28/2018	2019.01	05/28/2018 11:21:02 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	233	0	2019	State of Illinois		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	234	0		29	10	S5660_234_0	1	1				05/28/2018	2019.01	05/28/2018 11:04:34 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	234	0	2019	State of Missouri		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	235	0		29	10	S5660_235_0	1	1				05/28/2018	2019.01	05/28/2018 11:06:08 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	235	0	2019	State of Arkansas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	236	0		29	10	S5660_236_0	1	1				05/28/2018	2019.01	05/28/2018 11:06:59 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	236	0	2019	State of Mississippi		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	237	0		29	10	S5660_237_0	1	1				05/28/2018	2019.01	05/28/2018 11:22:06 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	237	0	2019	State of Louisiana		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	238	0		29	10	S5660_238_0	1	1				05/28/2018	2019.01	05/28/2018 11:44:52 AM Eastern Daylight Time		06/04/2018 08:53:17 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	238	0	2019	State of Texas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	239	0		29	10	S5660_239_0	1	1				05/28/2018	2019.01	05/28/2018 11:30:38 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	239	0	2019	State of Oklahoma		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	240	0		29	10	S5660_240_0	1	1				05/28/2018	2019.01	05/28/2018 11:31:29 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	240	0	2019	State of Kansas		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	241	0		29	10	S5660_241_0	1	1				05/28/2018	2019.01	05/28/2018 10:50:27 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	241	0	2019	Upper Midwest and Northern Plains		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	242	0		29	10	S5660_242_0	1	1				05/28/2018	2019.01	05/28/2018 11:08:08 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	242	0	2019	State of New Mexico		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	243	0		29	10	S5660_243_0	1	1				05/28/2018	2019.01	05/28/2018 11:47:15 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	243	0	2019	State of Colorado		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	244	0		29	10	S5660_244_0	1	1				05/28/2018	2019.01	05/28/2018 11:58:04 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	244	0	2019	State of Arizona		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	245	0		29	10	S5660_245_0	1	1				05/28/2018	2019.01	05/28/2018 11:32:46 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	245	0	2019	State of Nevada		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	246	0		29	10	S5660_246_0	1	1				05/28/2018	2019.01	05/28/2018 11:08:54 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	246	0	2019	States of Oregon and Washington		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	247	0		29	10	S5660_247_0	1	1				05/28/2018	2019.01	05/28/2018 11:33:33 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	247	0	2019	States of Idaho and Utah		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	248	0		29	10	S5660_248_0	1	1				05/28/2018	2019.01	05/28/2018 11:34:24 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	248	0	2019	State of California		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	249	0		29	10	S5660_249_0	1	1				05/28/2018	2019.01	05/28/2018 11:48:07 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	249	0	2019	State of Hawaii		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	250	0		29	10	S5660_250_0	1	1				05/28/2018	2019.01	05/28/2018 11:35:31 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	250	0	2019	State of Alaska		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	251	0		29	10	S5660_251_0	1	1				05/28/2018	2019.01	05/28/2018 11:58:44 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	251	0	2019	Puerto Rico		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	801	0		29	10	S5660_801_0	1	1				06/04/2018	2019.01	06/04/2018 02:14:47 PM Eastern Daylight Time					06/04/2018 02:17:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	801	0	2019	Premier Access Open 5 Tier		1					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	802	0		29	10	S5660_802_0	1	1				06/04/2018	2019.01	06/04/2018 02:14:54 PM Eastern Daylight Time					06/04/2018 02:17:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	802	0	2019	Premier Performance Closed 5 Tier		1					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	803	0		29	10	S5660_803_0	1	1				06/04/2018	2019.01	06/04/2018 02:15:01 PM Eastern Daylight Time					06/04/2018 02:17:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	803	0	2019	High Performance Closed 5 Tier		1					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	804	0		29	10	S5660_804_0	1	1				06/04/2018	2019.01	06/04/2018 02:15:07 PM Eastern Daylight Time					06/04/2018 02:17:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	804	0	2019	Premier Performance Closed 5 - Non Calendar		1					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	806	0		29	10	S5660_806_0	1	1				06/04/2018	2019.01	06/04/2018 02:15:15 PM Eastern Daylight Time					06/04/2018 02:17:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	806	0	2019	National - URMBT 3 Tier		1					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5715	001	0		29	10	S5715_001_0	4	1				05/31/2018	2019.01	05/31/2018 01:25:20 PM Central Daylight Time		06/20/2018 11:08:43 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getblueil.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	001	0	2019	State of Illinois		2					2						www.getblueil.com/pdp/pharmacies	www.getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	002	0		29	10	S5715_002_0	4	1				05/30/2018	2019.01	05/30/2018 09:41:05 AM Central Daylight Time		06/20/2018 11:08:42 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getblueil.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	002	0	2019	State of Illinois		2					2						www.getblueil.com/pdp/pharmacies	www.getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	003	0		29	10	S5715_003_0	4	1				06/03/2018	2019.01	06/03/2018 11:50:45 AM Central Daylight Time		06/20/2018 11:08:41 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getbluenm.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	003	0	2019	State of New Mexico		2					2						www.getbluenm.com/pdp/pharmacies	www.getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	004	0		29	10	S5715_004_0	4	1				06/03/2018	2019.01	06/03/2018 11:51:04 AM Central Daylight Time		06/20/2018 11:08:40 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getbluenm.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	004	0	2019	State of New Mexico		2					2						www.getbluenm.com/pdp/pharmacies	www.getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	005	0		29	10	S5715_005_0	4	1				05/30/2018	2019.01	05/30/2018 09:43:32 AM Central Daylight Time		06/20/2018 11:08:36 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getbluetx.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	005	0	2019	State of Texas		2					2						www.getbluetx.com/pdp/pharmacies	www.getbluetx.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	006	0		29	10	S5715_006_0	4	1				05/30/2018	2019.01	05/30/2018 09:45:47 AM Central Daylight Time		06/20/2018 11:07:28 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getbluetx.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	006	0	2019	State of Texas		2					2						www.getbluetx.com/pdp/pharmacies	www.getbluetx.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	010	0		29	10	S5715_010_0	4	1				05/30/2018	2019.01	05/30/2018 09:46:30 AM Central Daylight Time		06/20/2018 11:07:29 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getblueok.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	010	0	2019	State of Oklahoma		2					2						www.getblueok.com/pdp/pharmacies	www.getblueok.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	011	0		29	10	S5715_011_0	4	1				05/30/2018	2019.01	05/30/2018 09:47:04 AM Central Daylight Time		06/20/2018 11:07:30 AM Central Daylight Time			06/20/2018 03:40:25 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getblueok.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	011	0	2019	State of Oklahoma		2					2						www.getblueok.com/pdp/pharmacies	www.getblueok.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	012	0		29	10	S5715_012_0	3	1				06/03/2018	2019.01	06/03/2018 11:46:35 AM Central Daylight Time		06/02/2018 07:05:14 PM Central Daylight Time			06/04/2018 02:14:06 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getblueil.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	012	0	2019	State of Illinois		2					2						www.getblueil.com/pdp/pharmacies	www.getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	013	0		29	10	S5715_013_0	3	1				06/03/2018	2019.01	06/03/2018 11:47:28 AM Central Daylight Time		06/02/2018 07:05:55 PM Central Daylight Time			06/04/2018 02:14:06 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getbluenm.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	013	0	2019	State of New Mexico		2					2						www.getbluenm.com/pdp/pharmacies	www.getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	014	0		29	10	S5715_014_0	3	1				06/03/2018	2019.01	06/03/2018 11:48:14 AM Central Daylight Time		06/02/2018 07:06:36 PM Central Daylight Time			06/04/2018 02:14:06 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getbluetx.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	014	0	2019	State of Texas		2					2						www.getbluetx.com/pdp/pharmacies	www.getbluetx.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	015	0		29	10	S5715_015_0	3	1				06/03/2018	2019.01	06/03/2018 11:49:01 AM Central Daylight Time		06/02/2018 07:07:17 PM Central Daylight Time			06/04/2018 02:14:06 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.getblueok.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	015	0	2019	State of Oklahoma		2					2						www.getblueok.com/pdp/pharmacies	www.getblueok.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	801	0		29	10	S5715_801_0	1	1				04/09/2018	2019.01	04/09/2018 11:53:46 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	801	0	2019	State of Illinois		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	802	0		29	10	S5715_802_0	1	1				04/09/2018	2019.01	04/09/2018 11:53:51 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	802	0	2019	State of New Mexico		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	803	0		29	10	S5715_803_0	1	1				04/09/2018	2019.01	04/09/2018 11:53:59 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	803	0	2019	State of Texas		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	807	0		29	10	S5715_807_0	1	1				04/09/2018	2019.01	04/09/2018 11:54:06 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	807	0	2019	State of Oklahoma		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	809	0		29	10	S5715_809_0	1	1				04/09/2018	2019.01	04/09/2018 11:54:12 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	809	0	2019	State of Oklahoma		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	811	0		29	10	S5715_811_0	1	1				04/09/2018	2019.01	04/09/2018 11:54:18 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	811	0	2019	State of Illinois		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	813	0		29	10	S5715_813_0	1	1				04/09/2018	2019.01	04/09/2018 11:54:24 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	813	0	2019	State of New Mexico		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	815	0		29	10	S5715_815_0	1	1				04/09/2018	2019.01	04/09/2018 11:54:29 AM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	815	0	2019	State of Texas		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	817	0		29	10	S5715_817_0	1	1				05/23/2018	2019.01	05/23/2018 03:59:35 PM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	817	0	2019	Illinois, New Mexico, Oklahoma and Texas		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	818	0		29	10	S5715_818_0	1	1				05/23/2018	2019.01	05/23/2018 03:59:43 PM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	818	0	2019	Illinois, New Mexico, Oklahoma, Texas		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	819	0		29	10	S5715_819_0	1	1				05/23/2018	2019.01	05/23/2018 03:59:49 PM Central Daylight Time					05/25/2018 11:37:32 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	819	0	2019	Illinois, New Mexico, Oklahoma, Texas		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5726	013	0		29	10	S5726_013_0	3	1				05/30/2018	2019.01	05/30/2018 01:12:03 PM Eastern Daylight Time		07/10/2018 03:14:56 PM Eastern Daylight Time			07/13/2018 01:06:30 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	https://shop.partdkansas.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5726	013	0	2019	Kansas		2					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	014	0		29	10	S5726_014_0	1	1				05/30/2018	2019.01	05/30/2018 01:12:52 PM Eastern Daylight Time		05/30/2018 05:03:06 PM Eastern Daylight Time			06/01/2018 08:45:04 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	https://shop.partdkansas.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5726	014	0	2019	Kansas		2					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	805	0		29	10	S5726_805_0	1	1				06/01/2018	2019.01	06/01/2018 08:42:43 AM Eastern Daylight Time					06/01/2018 08:45:04 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	https://shop.partdkansas.com/medicare	Blue MedicareRx (PDP)	10	29					S5726	805	0	2019	Kansas		1					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)830-0174		(866)830-0174		(866)830-0296		(866)830-0296										(711)-		(711)-		(711)-		(711)-																
S5743	001	0		29	10	S5743_001_0	3	1				06/02/2018	2019.01	06/02/2018 04:07:25 PM Central Daylight Time		07/24/2018 10:04:36 AM Central Daylight Time			07/24/2018 10:26:32 AM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	MedicareBlue Rx Standard (PDP)	10	29					S5743	001	0	2019	States of IA, MN, MT, NE, ND, SD, WY		2					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5743	004	0		29	10	S5743_004_0	2	1				06/02/2018	2019.01	06/02/2018 04:22:23 PM Central Daylight Time		06/01/2018 11:45:46 PM Central Daylight Time			06/02/2018 04:30:22 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	MedicareBlue Rx Premier (PDP)	10	29					S5743	004	0	2019	States of IA, MN, MT, NE, ND, SD, WY		2					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5743	802	0		29	10	S5743_802_0	1	1				05/31/2018	2019.01	05/31/2018 02:08:13 PM Central Daylight Time					05/31/2018 02:13:17 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	Group MedicareBlue Rx (PDP)	10	29					S5743	802	0	2019	Nationwide		1					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(877)838-3827		(877)838-3827		(866)456-2885		(866)456-2885										(711)-		(711)-		(711)-		(711)-																
S5743	805	0		29	10	S5743_805_0	1	1				04/13/2018	2019.01	04/13/2018 10:33:20 AM Central Daylight Time					05/31/2018 02:13:17 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	Group MedicareBlue Rx Self-funded (PDP)	10	29					S5743	805	0	2019	Nationwide		1					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(877)838-3827		(877)838-3827		(866)456-2885		(866)456-2885										(711)-		(711)-		(711)-		(711)-																
S5753	006	0		29	10	S5753_006_0	3	1				06/01/2018	2019.01	06/01/2018 03:55:16 PM Central Daylight Time		06/01/2018 03:56:10 PM Central Daylight Time			06/01/2018 04:01:56 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 1 (PDP)	10	29					S5753	006	0	2019	State of Wisconsin		2					2						www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com										(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5753	007	0		29	10	S5753_007_0	4	1				07/13/2018	2019.01	07/13/2018 02:24:13 PM Central Daylight Time		07/11/2018 12:38:44 PM Central Daylight Time			07/13/2018 02:25:00 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 2 (PDP)	10	29					S5753	007	0	2019	State of Wisconsin		2					2						www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com										(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5768	125	0		29	10	S5768_125_0	1	1				05/22/2018	2019.01	05/22/2018 01:53:40 PM Eastern Daylight Time		05/28/2018 06:54:57 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	125	0	2019	Northern New England (NH, ME)		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	126	0		29	10	S5768_126_0	1	1				05/22/2018	2019.01	05/22/2018 02:07:17 PM Eastern Daylight Time		05/28/2018 06:55:57 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	126	0	2019	Central New England  (CT, RI, MA, VT)		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	127	0		29	10	S5768_127_0	1	1				05/22/2018	2019.01	05/22/2018 02:35:00 PM Eastern Daylight Time		05/28/2018 06:56:49 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	127	0	2019	New Jersey		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	128	0		29	10	S5768_128_0	1	1				05/22/2018	2019.01	05/22/2018 02:15:13 PM Eastern Daylight Time		05/28/2018 06:57:46 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	128	0	2019	Mid-Atlantic (DE, DC, MD)		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	129	0		29	10	S5768_129_0	1	1				05/22/2018	2019.01	05/22/2018 01:59:20 PM Eastern Daylight Time		05/28/2018 06:58:40 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	129	0	2019	Pennsylvania, West Virginia		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	130	0		29	10	S5768_130_0	1	1				05/22/2018	2019.01	05/22/2018 02:56:18 PM Eastern Daylight Time		05/28/2018 06:59:41 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	130	0	2019	Virginia		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	131	0		29	10	S5768_131_0	1	1				05/22/2018	2019.01	05/22/2018 04:45:36 PM Eastern Daylight Time		05/28/2018 07:00:38 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	131	0	2019	North Carolina		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	132	0		29	10	S5768_132_0	1	1				05/22/2018	2019.01	05/22/2018 02:22:11 PM Eastern Daylight Time		05/28/2018 07:01:38 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	132	0	2019	South Carolina		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	133	0		29	10	S5768_133_0	1	1				05/22/2018	2019.01	05/22/2018 02:59:00 PM Eastern Daylight Time		05/28/2018 07:02:36 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	133	0	2019	Georgia		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	134	0		29	10	S5768_134_0	1	1				05/22/2018	2019.01	05/22/2018 02:25:50 PM Eastern Daylight Time		05/28/2018 07:03:28 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	134	0	2019	Florida		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	135	0		29	10	S5768_135_0	1	1				05/22/2018	2019.01	05/22/2018 03:05:37 PM Eastern Daylight Time		05/28/2018 07:04:24 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	135	0	2019	Alabama, Tennessee		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	136	0		29	10	S5768_136_0	1	1				05/22/2018	2019.01	05/22/2018 03:07:48 PM Eastern Daylight Time		05/28/2018 07:05:23 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	136	0	2019	Michigan		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	137	0		29	10	S5768_137_0	1	1				05/22/2018	2019.01	05/22/2018 02:27:18 PM Eastern Daylight Time		05/28/2018 07:06:24 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	137	0	2019	Ohio		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	138	0		29	10	S5768_138_0	1	1				05/22/2018	2019.01	05/22/2018 03:13:56 PM Eastern Daylight Time		05/28/2018 07:07:22 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	138	0	2019	Indiana, Kentucky		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	139	0		29	10	S5768_139_0	1	1				05/22/2018	2019.01	05/22/2018 03:11:05 PM Eastern Daylight Time		05/28/2018 07:08:20 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	139	0	2019	Wisconsin		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	140	0		29	10	S5768_140_0	1	1				05/22/2018	2019.01	05/22/2018 02:29:16 PM Eastern Daylight Time		05/28/2018 07:09:19 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	140	0	2019	Illinois		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	141	0		29	10	S5768_141_0	2	1				05/22/2018	2019.01	05/22/2018 02:01:11 PM Eastern Daylight Time		07/20/2018 03:18:31 PM Eastern Daylight Time			07/24/2018 08:51:28 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	141	0	2019	Missouri		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	142	0		29	10	S5768_142_0	1	1				05/22/2018	2019.01	05/22/2018 03:17:10 PM Eastern Daylight Time		05/28/2018 07:11:13 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	142	0	2019	Arkansas		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	143	0		29	10	S5768_143_0	1	1				05/22/2018	2019.01	05/22/2018 03:00:14 PM Eastern Daylight Time		05/28/2018 07:12:12 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	143	0	2019	Mississippi		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	144	0		29	10	S5768_144_0	1	1				05/22/2018	2019.01	05/22/2018 03:01:27 PM Eastern Daylight Time		05/28/2018 07:13:05 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	144	0	2019	Louisiana		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	145	0		29	10	S5768_145_0	1	1				05/22/2018	2019.01	05/22/2018 03:18:17 PM Eastern Daylight Time		05/28/2018 07:14:00 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	145	0	2019	Texas		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	146	0		29	10	S5768_146_0	1	1				05/22/2018	2019.01	05/22/2018 02:38:27 PM Eastern Daylight Time		05/28/2018 07:14:54 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	146	0	2019	Oklahoma		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	147	0		29	10	S5768_147_0	1	1				05/22/2018	2019.01	05/22/2018 02:02:45 PM Eastern Daylight Time		05/28/2018 07:15:46 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	147	0	2019	Kansas		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	148	0		29	10	S5768_148_0	1	1				05/22/2018	2019.01	05/22/2018 02:04:08 PM Eastern Daylight Time		05/28/2018 07:16:43 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	148	0	2019	Upper MW and N Plains (IA, MN, NE, SD, ND, WY, MT)		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	149	0		29	10	S5768_149_0	1	1				05/22/2018	2019.01	05/22/2018 03:21:52 PM Eastern Daylight Time		05/28/2018 07:17:42 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	149	0	2019	New Mexico		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	150	0		29	10	S5768_150_0	1	1				05/22/2018	2019.01	05/22/2018 03:09:00 PM Eastern Daylight Time		05/28/2018 07:18:34 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	150	0	2019	Colorado		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	151	0		29	10	S5768_151_0	1	1				05/22/2018	2019.01	05/22/2018 02:39:42 PM Eastern Daylight Time		05/28/2018 07:19:28 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	151	0	2019	Arizona		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	152	0		29	10	S5768_152_0	1	1				05/22/2018	2019.01	05/22/2018 03:23:40 PM Eastern Daylight Time		05/28/2018 07:20:20 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	152	0	2019	Nevada		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	153	0		29	10	S5768_153_0	1	1				05/22/2018	2019.01	05/22/2018 02:41:04 PM Eastern Daylight Time		05/28/2018 07:21:12 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	153	0	2019	Oregon, Washington		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	154	0		29	10	S5768_154_0	1	1				05/22/2018	2019.01	05/22/2018 03:02:54 PM Eastern Daylight Time		05/28/2018 07:22:06 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	154	0	2019	Idaho, Utah		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	155	0		29	10	S5768_155_0	1	1				05/22/2018	2019.01	05/22/2018 02:42:22 PM Eastern Daylight Time		05/28/2018 07:23:07 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	155	0	2019	California		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	197	0		29	10	S5768_197_0	1	1				05/22/2018	2019.01	05/22/2018 02:43:42 PM Eastern Daylight Time		05/28/2018 07:24:01 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	197	0	2019	Alaska		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	198	0		29	10	S5768_198_0	2	1				05/22/2018	2019.01	05/22/2018 02:31:07 PM Eastern Daylight Time		07/20/2018 03:21:20 PM Eastern Daylight Time			07/24/2018 08:51:28 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	198	0	2019	Hawaii		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	200	0		29	10	S5768_200_0	1	1				05/25/2018	2019.01	05/25/2018 03:13:56 PM Eastern Daylight Time		05/28/2018 07:26:01 PM Eastern Daylight Time			05/31/2018 10:30:53 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	http://www.FirstHealthPartD.com	Aetna Medicare Rx Value Plus (PDP)	10	29					S5768	200	0	2019	New York		2					2						http://www.FirstHealthPartD.com	http://www.FirstHealthPartD.com										(844)233-1938		(844)233-1938		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5795	002	0		29	10	S5795_002_0	3	1				06/03/2018	2019.01	06/03/2018 02:14:04 PM Central Daylight Time		07/23/2018 09:34:53 AM Central Daylight Time			07/23/2018 09:35:31 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Rx Premier (PDP)	10	29					S5795	002	0	2019	State of Arkansas		2					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	003	0		29	10	S5795_003_0	3	1				06/03/2018	2019.01	06/03/2018 02:17:31 PM Central Daylight Time		07/23/2018 09:34:50 AM Central Daylight Time			07/23/2018 09:35:31 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Rx Basic (PDP)	10	29					S5795	003	0	2019	State of Arkansas		2					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	804	0		29	10	S5795_804_0	3	1				05/30/2018	2019.01	05/30/2018 11:21:17 AM Central Daylight Time					06/04/2018 10:18:28 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer CY 4 (PDP)	10	29					S5795	804	0	2019	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	809	0		29	10	S5795_809_0	3	1				05/30/2018	2019.01	05/30/2018 11:22:26 AM Central Daylight Time					06/04/2018 10:18:28 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer NCY 4 (PDP)	10	29					S5795	809	0	2019	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	811	0		29	10	S5795_811_0	3	1				05/29/2018	2019.01	05/29/2018 07:59:25 AM Central Daylight Time					06/04/2018 10:18:28 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	ABCBS Group Basic CY (PDP)	10	29					S5795	811	0	2019	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	812	0		29	10	S5795_812_0	3	1				05/29/2018	2019.01	05/29/2018 07:59:31 AM Central Daylight Time					06/04/2018 10:18:28 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	ABCBS Group Basic PY (PDP)	10	29					S5795	812	0	2019	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5805	001	0		29	10	S5805_001_0	1	1				05/23/2018	2019.01	05/23/2018 06:22:32 PM Central Daylight Time		05/30/2018 09:53:50 AM Central Daylight Time			06/01/2018 02:17:33 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5805	001	0	2019	New York		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	803	0		29	10	S5805_803_0	1	1				05/24/2018	2019.01	05/24/2018 04:28:36 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	803	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	804	0		29	10	S5805_804_0	1	1				05/24/2018	2019.01	05/24/2018 04:28:41 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	804	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	807	0		29	10	S5805_807_0	1	1				05/24/2018	2019.01	05/24/2018 04:28:45 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	807	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	808	0		29	10	S5805_808_0	1	1				05/24/2018	2019.01	05/24/2018 04:28:49 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	808	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	809	0		29	10	S5805_809_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:02 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	809	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	810	0		29	10	S5805_810_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:07 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	810	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	811	0		29	10	S5805_811_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:12 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	811	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	812	0		29	10	S5805_812_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:18 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	812	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	813	0		29	10	S5805_813_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:23 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	813	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	814	0		29	10	S5805_814_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:28 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	814	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	815	0		29	10	S5805_815_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:33 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	815	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	816	0		29	10	S5805_816_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:42 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	816	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	818	0		29	10	S5805_818_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:47 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	818	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	819	0		29	10	S5805_819_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:53 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	819	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	820	0		29	10	S5805_820_0	1	1				05/24/2018	2019.01	05/24/2018 04:29:59 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	820	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	821	0		29	10	S5805_821_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:04 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	821	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	822	0		29	10	S5805_822_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:09 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	822	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	823	0		29	10	S5805_823_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:27 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	823	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	824	0		29	10	S5805_824_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:32 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	824	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	825	0		29	10	S5805_825_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:36 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	825	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	826	0		29	10	S5805_826_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:41 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	826	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	827	0		29	10	S5805_827_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:45 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	827	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	828	0		29	10	S5805_828_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:49 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	828	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	829	0		29	10	S5805_829_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:53 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	829	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	830	0		29	10	S5805_830_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:58 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	830	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	831	0		29	10	S5805_831_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:04 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	831	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	832	0		29	10	S5805_832_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:09 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	832	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	833	0		29	10	S5805_833_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:14 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	833	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	834	0		29	10	S5805_834_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:18 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	834	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	835	0		29	10	S5805_835_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:23 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	835	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	836	0		29	10	S5805_836_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:27 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	836	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	837	0		29	10	S5805_837_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:33 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	837	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	838	0		29	10	S5805_838_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:38 PM Central Daylight Time					06/02/2018 03:17:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	838	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5810	035	0		29	10	S5810_035_0	1	1				05/25/2018	2019.01	05/25/2018 03:12:58 PM Eastern Daylight Time		05/28/2018 07:26:52 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	035	0	2019	Northern New England (NH, ME)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	036	0		29	10	S5810_036_0	1	1				05/21/2018	2019.01	05/21/2018 04:41:36 PM Eastern Daylight Time		05/28/2018 07:27:54 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	036	0	2019	Central New England  (CT, RI, MA, VT)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	037	0		29	10	S5810_037_0	1	1				05/21/2018	2019.01	05/21/2018 02:54:16 PM Eastern Daylight Time		05/28/2018 07:28:52 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	037	0	2019	New  York		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	038	0		29	10	S5810_038_0	1	1				05/21/2018	2019.01	05/21/2018 03:01:28 PM Eastern Daylight Time		05/28/2018 07:29:44 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	038	0	2019	New Jersey		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	039	0		29	10	S5810_039_0	1	1				05/21/2018	2019.01	05/21/2018 02:59:43 PM Eastern Daylight Time		05/28/2018 07:30:39 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	039	0	2019	Mid-Atlantic (DE, DC, MD)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	040	0		29	10	S5810_040_0	1	1				05/21/2018	2019.01	05/21/2018 03:19:28 PM Eastern Daylight Time		05/28/2018 07:31:31 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	040	0	2019	Pennsylvania, West Virginia		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	041	0		29	10	S5810_041_0	1	1				05/21/2018	2019.01	05/21/2018 03:20:48 PM Eastern Daylight Time		05/28/2018 07:32:23 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	041	0	2019	Virginia		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	042	0		29	10	S5810_042_0	1	1				05/21/2018	2019.01	05/21/2018 03:22:33 PM Eastern Daylight Time		05/28/2018 07:33:22 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	042	0	2019	North Carolina		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	043	0		29	10	S5810_043_0	1	1				05/21/2018	2019.01	05/21/2018 03:26:03 PM Eastern Daylight Time		05/28/2018 07:34:21 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	043	0	2019	South Carolina		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	044	0		29	10	S5810_044_0	1	1				05/21/2018	2019.01	05/21/2018 03:29:09 PM Eastern Daylight Time		05/28/2018 07:35:17 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	044	0	2019	Georgia		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	045	0		29	10	S5810_045_0	1	1				05/21/2018	2019.01	05/21/2018 03:31:21 PM Eastern Daylight Time		05/28/2018 07:36:14 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	045	0	2019	Florida		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	046	0		29	10	S5810_046_0	1	1				05/21/2018	2019.01	05/21/2018 03:35:34 PM Eastern Daylight Time		05/28/2018 07:37:08 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	046	0	2019	Alabama, Tennessee		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	047	0		29	10	S5810_047_0	1	1				05/21/2018	2019.01	05/21/2018 03:37:47 PM Eastern Daylight Time		05/28/2018 07:38:01 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	047	0	2019	Michigan		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	048	0		29	10	S5810_048_0	1	1				05/21/2018	2019.01	05/21/2018 03:40:24 PM Eastern Daylight Time		05/28/2018 07:38:54 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	048	0	2019	Ohio		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	049	0		29	10	S5810_049_0	1	1				05/21/2018	2019.01	05/21/2018 04:51:50 PM Eastern Daylight Time		05/28/2018 07:39:47 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	049	0	2019	Indiana, Kentucky		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	050	0		29	10	S5810_050_0	1	1				05/21/2018	2019.01	05/21/2018 03:50:43 PM Eastern Daylight Time		05/28/2018 07:40:42 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	050	0	2019	Wisconsin		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	051	0		29	10	S5810_051_0	1	1				05/21/2018	2019.01	05/21/2018 03:52:51 PM Eastern Daylight Time		05/28/2018 07:41:35 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	051	0	2019	Illinois		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	052	0		29	10	S5810_052_0	1	1				05/21/2018	2019.01	05/21/2018 03:54:22 PM Eastern Daylight Time		05/28/2018 07:42:28 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	052	0	2019	Missouri		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	053	0		29	10	S5810_053_0	1	1				05/21/2018	2019.01	05/21/2018 03:56:15 PM Eastern Daylight Time		05/28/2018 07:43:21 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	053	0	2019	Arkansas		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	054	0		29	10	S5810_054_0	1	1				05/21/2018	2019.01	05/21/2018 03:57:33 PM Eastern Daylight Time		05/28/2018 07:44:17 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	054	0	2019	Mississippi		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	055	0		29	10	S5810_055_0	1	1				05/21/2018	2019.01	05/21/2018 03:59:18 PM Eastern Daylight Time		05/28/2018 07:45:13 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	055	0	2019	Louisiana		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	056	0		29	10	S5810_056_0	1	1				05/21/2018	2019.01	05/21/2018 04:01:36 PM Eastern Daylight Time		05/28/2018 07:46:05 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	056	0	2019	Texas		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	057	0		29	10	S5810_057_0	1	1				05/21/2018	2019.01	05/21/2018 04:03:17 PM Eastern Daylight Time		05/28/2018 07:46:56 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	057	0	2019	Oklahoma		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	058	0		29	10	S5810_058_0	1	1				05/21/2018	2019.01	05/21/2018 05:05:44 PM Eastern Daylight Time		05/28/2018 07:47:47 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	058	0	2019	Kansas		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	059	0		29	10	S5810_059_0	1	1				05/21/2018	2019.01	05/21/2018 04:05:36 PM Eastern Daylight Time		05/28/2018 07:48:40 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	059	0	2019	Upper MW and N Plains (IA, MN, NE, SD, ND, WY, MT)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	060	0		29	10	S5810_060_0	1	1				05/21/2018	2019.01	05/21/2018 04:07:25 PM Eastern Daylight Time		05/28/2018 07:49:39 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	060	0	2019	New Mexico		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	061	0		29	10	S5810_061_0	1	1				05/21/2018	2019.01	05/21/2018 04:09:03 PM Eastern Daylight Time		05/28/2018 07:50:34 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	061	0	2019	Colorado		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	062	0		29	10	S5810_062_0	1	1				05/21/2018	2019.01	05/21/2018 04:10:29 PM Eastern Daylight Time		05/28/2018 07:51:27 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	062	0	2019	Arizona		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	063	0		29	10	S5810_063_0	1	1				05/21/2018	2019.01	05/21/2018 04:12:02 PM Eastern Daylight Time		05/28/2018 07:52:20 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	063	0	2019	Nevada		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	064	0		29	10	S5810_064_0	1	1				05/21/2018	2019.01	05/21/2018 04:14:10 PM Eastern Daylight Time		05/28/2018 07:53:18 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	064	0	2019	Oregon, Washington		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	065	0		29	10	S5810_065_0	1	1				05/21/2018	2019.01	05/21/2018 04:15:28 PM Eastern Daylight Time		05/28/2018 07:54:14 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	065	0	2019	Idaho, Utah		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	066	0		29	10	S5810_066_0	1	1				05/21/2018	2019.01	05/21/2018 04:16:43 PM Eastern Daylight Time		05/28/2018 07:55:07 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	066	0	2019	California		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	067	0		29	10	S5810_067_0	1	1				05/21/2018	2019.01	05/21/2018 04:20:30 PM Eastern Daylight Time		05/28/2018 07:56:00 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	067	0	2019	Hawaii		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	068	0		29	10	S5810_068_0	1	1				05/21/2018	2019.01	05/21/2018 04:22:13 PM Eastern Daylight Time		05/28/2018 07:56:55 PM Eastern Daylight Time			05/31/2018 10:41:15 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	068	0	2019	Alaska		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	276	0		29	10	S5810_276_0	2	1				05/22/2018	2019.01	05/22/2018 09:47:44 AM Eastern Daylight Time		05/28/2018 07:57:48 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	276	0	2019	Central New England (CT, RI, MA, VT)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	277	0		29	10	S5810_277_0	2	1				05/22/2018	2019.01	05/22/2018 10:01:37 AM Eastern Daylight Time		05/28/2018 07:58:42 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	277	0	2019	New York		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	278	0		29	10	S5810_278_0	2	1				05/22/2018	2019.01	05/22/2018 10:05:33 AM Eastern Daylight Time		05/28/2018 07:59:34 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	278	0	2019	New Jersey		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	279	0		29	10	S5810_279_0	2	1				05/22/2018	2019.01	05/22/2018 10:16:53 AM Eastern Daylight Time		05/28/2018 08:00:29 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	279	0	2019	Mid-Atlantic (DE, DC, MD)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	280	0		29	10	S5810_280_0	2	1				05/22/2018	2019.01	05/22/2018 10:18:28 AM Eastern Daylight Time		05/28/2018 08:01:26 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	280	0	2019	Pennsylvania, West Virginia		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	281	0		29	10	S5810_281_0	2	1				05/22/2018	2019.01	05/22/2018 10:48:24 AM Eastern Daylight Time		05/28/2018 08:02:24 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	281	0	2019	Virginia		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	282	0		29	10	S5810_282_0	2	1				05/22/2018	2019.01	05/22/2018 10:50:51 AM Eastern Daylight Time		05/28/2018 08:03:20 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	282	0	2019	North Carolina		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	283	0		29	10	S5810_283_0	2	1				05/22/2018	2019.01	05/22/2018 10:51:49 AM Eastern Daylight Time		05/28/2018 08:04:17 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	283	0	2019	South Carolina		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	284	0		29	10	S5810_284_0	2	1				05/22/2018	2019.01	05/22/2018 10:55:17 AM Eastern Daylight Time		05/28/2018 08:05:10 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	284	0	2019	Georgia		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	285	0		29	10	S5810_285_0	2	1				05/22/2018	2019.01	05/22/2018 10:56:22 AM Eastern Daylight Time		05/28/2018 08:06:03 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	285	0	2019	Florida		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	286	0		29	10	S5810_286_0	2	1				05/22/2018	2019.01	05/22/2018 11:00:58 AM Eastern Daylight Time		05/28/2018 08:06:54 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	286	0	2019	Alabama, Tennessee		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	287	0		29	10	S5810_287_0	2	1				05/22/2018	2019.01	05/22/2018 11:05:23 AM Eastern Daylight Time		05/28/2018 08:07:46 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	287	0	2019	Michigan		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	288	0		29	10	S5810_288_0	2	1				05/22/2018	2019.01	05/22/2018 11:07:43 AM Eastern Daylight Time		05/28/2018 08:08:39 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	288	0	2019	Ohio		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	289	0		29	10	S5810_289_0	2	1				05/22/2018	2019.01	05/22/2018 11:08:38 AM Eastern Daylight Time		05/28/2018 08:09:32 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	289	0	2019	Indiana, Kentucky		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	290	0		29	10	S5810_290_0	2	1				05/22/2018	2019.01	05/22/2018 11:10:04 AM Eastern Daylight Time		05/28/2018 08:10:25 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	290	0	2019	Wisconsin		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	291	0		29	10	S5810_291_0	2	1				05/22/2018	2019.01	05/22/2018 11:12:07 AM Eastern Daylight Time		05/28/2018 08:11:17 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	291	0	2019	Illinois		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	292	0		29	10	S5810_292_0	2	1				05/22/2018	2019.01	05/22/2018 11:13:45 AM Eastern Daylight Time		05/28/2018 08:12:08 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	292	0	2019	Louisiana		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	293	0		29	10	S5810_293_0	2	1				05/22/2018	2019.01	05/22/2018 11:14:53 AM Eastern Daylight Time		05/28/2018 08:13:01 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	293	0	2019	Texas		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	294	0		29	10	S5810_294_0	2	1				05/22/2018	2019.01	05/22/2018 12:13:53 PM Eastern Daylight Time		05/28/2018 08:13:53 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	294	0	2019	Arizona		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	295	0		29	10	S5810_295_0	2	1				05/22/2018	2019.01	05/22/2018 12:17:09 PM Eastern Daylight Time		05/28/2018 08:14:47 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	295	0	2019	California		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	296	0		29	10	S5810_296_0	2	1				05/22/2018	2019.01	05/22/2018 12:19:57 PM Eastern Daylight Time		05/28/2018 08:15:40 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	296	0	2019	Northern New England (NH, ME)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	297	0		29	10	S5810_297_0	2	1				05/22/2018	2019.01	05/22/2018 12:21:25 PM Eastern Daylight Time		05/28/2018 08:16:32 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	297	0	2019	Missouri		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	298	0		29	10	S5810_298_0	2	1				05/22/2018	2019.01	05/22/2018 12:22:45 PM Eastern Daylight Time		05/28/2018 08:17:24 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	298	0	2019	Arkansas		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	299	0		29	10	S5810_299_0	2	1				05/22/2018	2019.01	05/22/2018 12:23:48 PM Eastern Daylight Time		05/28/2018 08:18:17 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	299	0	2019	Mississippi		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	300	0		29	10	S5810_300_0	2	1				05/22/2018	2019.01	05/22/2018 12:25:22 PM Eastern Daylight Time		05/28/2018 08:19:09 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	300	0	2019	Oklahoma		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	301	0		29	10	S5810_301_0	2	1				05/22/2018	2019.01	05/22/2018 12:27:03 PM Eastern Daylight Time		05/28/2018 08:20:01 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	301	0	2019	Kansas		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	302	0		29	10	S5810_302_0	2	1				05/22/2018	2019.01	05/22/2018 12:27:59 PM Eastern Daylight Time		05/28/2018 08:20:52 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	302	0	2019	Upper MW and N Plains (IA, MN, NE, SD, ND, WY, MT)		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	303	0		29	10	S5810_303_0	2	1				05/22/2018	2019.01	05/22/2018 12:29:39 PM Eastern Daylight Time		05/28/2018 08:21:45 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	303	0	2019	New Mexico		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	304	0		29	10	S5810_304_0	2	1				05/22/2018	2019.01	05/22/2018 12:30:45 PM Eastern Daylight Time		05/28/2018 08:22:38 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	304	0	2019	Colorado		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	305	0		29	10	S5810_305_0	2	1				05/22/2018	2019.01	05/22/2018 12:31:45 PM Eastern Daylight Time		05/28/2018 08:23:31 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	305	0	2019	Nevada		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	306	0		29	10	S5810_306_0	2	1				05/22/2018	2019.01	05/22/2018 12:32:33 PM Eastern Daylight Time		05/28/2018 08:24:25 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	306	0	2019	Oregon, Washington		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	307	0		29	10	S5810_307_0	2	1				05/22/2018	2019.01	05/22/2018 12:33:36 PM Eastern Daylight Time		05/28/2018 08:25:20 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	307	0	2019	Idaho, Utah		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	308	0		29	10	S5810_308_0	2	1				05/22/2018	2019.01	05/22/2018 12:34:24 PM Eastern Daylight Time		05/28/2018 08:26:13 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	308	0	2019	Hawaii		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	309	0		29	10	S5810_309_0	2	1				05/22/2018	2019.01	05/22/2018 12:35:50 PM Eastern Daylight Time		05/28/2018 08:27:07 PM Eastern Daylight Time			05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Select (PDP)	10	29					S5810	309	0	2019	Alaska		2					2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary										(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	801	0		29	10	S5810_801_0	1	1				05/31/2018	2019.01	05/31/2018 10:22:05 AM Eastern Daylight Time					05/31/2018 11:00:11 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Plan (PDP)	10	29					S5810	801	0	2019	Employer National		1					2						https://www.aetnamedicare.com/findpharmacy	www.aetnaretireeplans.com										(800)594-9390		(800)594-9390		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-																
S5820	001	0		29	10	S5820_001_0	1	1				05/24/2018	2019.01	05/24/2018 11:55:56 AM Central Daylight Time		05/30/2018 09:54:16 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	001	0	2019	Northern New England (NH, ME)		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	002	0		29	10	S5820_002_0	1	1				05/24/2018	2019.01	05/24/2018 04:08:15 PM Central Daylight Time		05/30/2018 09:54:38 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	002	0	2019	Central New England (CT, MA, RI, VT)		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	003	0		29	10	S5820_003_0	1	1				05/24/2018	2019.01	05/24/2018 04:08:42 PM Central Daylight Time		05/30/2018 09:55:06 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	003	0	2019	New Jersey		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	004	0		29	10	S5820_004_0	1	1				05/24/2018	2019.01	05/24/2018 04:09:31 PM Central Daylight Time		05/30/2018 09:55:34 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	004	0	2019	Mid-Atlantic (DE, DC, MD)		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	005	0		29	10	S5820_005_0	1	1				05/24/2018	2019.01	05/24/2018 04:10:04 PM Central Daylight Time		05/30/2018 09:55:56 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	005	0	2019	Pennsylvania, West Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	006	0		29	10	S5820_006_0	1	1				05/24/2018	2019.01	05/24/2018 04:10:35 PM Central Daylight Time		05/30/2018 09:56:20 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	006	0	2019	Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	007	0		29	10	S5820_007_0	1	1				05/24/2018	2019.01	05/24/2018 04:11:07 PM Central Daylight Time		05/30/2018 09:56:42 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	007	0	2019	North Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	008	0		29	10	S5820_008_0	1	1				05/24/2018	2019.01	05/24/2018 04:11:38 PM Central Daylight Time		05/30/2018 09:57:06 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	008	0	2019	South Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	009	0		29	10	S5820_009_0	1	1				05/24/2018	2019.01	05/24/2018 04:12:06 PM Central Daylight Time		05/30/2018 09:57:28 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	009	0	2019	Georgia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	010	0		29	10	S5820_010_0	1	1				05/24/2018	2019.01	05/24/2018 04:12:49 PM Central Daylight Time		05/30/2018 09:57:52 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	010	0	2019	Florida		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	011	0		29	10	S5820_011_0	1	1				05/24/2018	2019.01	05/24/2018 04:13:20 PM Central Daylight Time		05/30/2018 09:58:16 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	011	0	2019	Alabama, Tennessee		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	012	0		29	10	S5820_012_0	1	1				05/24/2018	2019.01	05/24/2018 04:13:52 PM Central Daylight Time		05/30/2018 09:58:38 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	012	0	2019	Michigan		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	013	0		29	10	S5820_013_0	1	1				05/24/2018	2019.01	05/24/2018 04:14:25 PM Central Daylight Time		05/30/2018 09:59:02 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	013	0	2019	Ohio		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	014	0		29	10	S5820_014_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:33 PM Central Daylight Time		05/30/2018 09:59:24 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	014	0	2019	Indiana, Kentucky		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	015	0		29	10	S5820_015_0	1	1				05/24/2018	2019.01	05/24/2018 04:15:29 PM Central Daylight Time		05/30/2018 09:59:48 AM Central Daylight Time			06/01/2018 02:29:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	015	0	2019	Wisconsin		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	016	0		29	10	S5820_016_0	1	1				05/24/2018	2019.01	05/24/2018 04:16:04 PM Central Daylight Time		05/30/2018 10:00:12 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	016	0	2019	Illinois		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	017	0		29	10	S5820_017_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:07 PM Central Daylight Time		05/30/2018 10:00:34 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	017	0	2019	Missouri		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	018	0		29	10	S5820_018_0	1	1				05/24/2018	2019.01	05/24/2018 04:17:12 PM Central Daylight Time		05/30/2018 10:00:58 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	018	0	2019	Arkansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	019	0		29	10	S5820_019_0	1	1				05/24/2018	2019.01	05/24/2018 04:17:54 PM Central Daylight Time		05/30/2018 10:01:20 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	019	0	2019	Mississippi		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	020	0		29	10	S5820_020_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:44 PM Central Daylight Time		05/30/2018 10:01:44 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	020	0	2019	Louisiana		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	021	0		29	10	S5820_021_0	1	1				05/24/2018	2019.01	05/24/2018 04:18:48 PM Central Daylight Time		05/30/2018 10:02:08 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	021	0	2019	Texas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	022	0		29	10	S5820_022_0	1	1				05/24/2018	2019.01	05/24/2018 04:19:33 PM Central Daylight Time		05/30/2018 10:02:30 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	022	0	2019	Oklahoma		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	023	0		29	10	S5820_023_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:11 PM Central Daylight Time		05/30/2018 10:02:54 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	023	0	2019	Kansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	024	0		29	10	S5820_024_0	1	1				05/24/2018	2019.01	05/24/2018 04:20:37 PM Central Daylight Time		05/30/2018 10:03:16 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	024	0	2019	Upper Midwest and Northern Plains		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	025	0		29	10	S5820_025_0	1	1				05/24/2018	2019.01	05/24/2018 04:21:16 PM Central Daylight Time		05/30/2018 10:03:40 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	025	0	2019	New Mexico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	026	0		29	10	S5820_026_0	1	1				05/24/2018	2019.01	05/24/2018 04:21:50 PM Central Daylight Time		05/30/2018 10:04:02 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	026	0	2019	Colorado		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	027	0		29	10	S5820_027_0	1	1				05/24/2018	2019.01	05/24/2018 04:22:20 PM Central Daylight Time		05/30/2018 10:04:26 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	027	0	2019	Arizona		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	028	0		29	10	S5820_028_0	1	1				05/24/2018	2019.01	05/24/2018 04:22:49 PM Central Daylight Time		05/30/2018 10:04:50 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	028	0	2019	Nevada		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	029	0		29	10	S5820_029_0	1	1				05/27/2018	2019.01	05/27/2018 01:39:40 PM Central Daylight Time		05/30/2018 10:05:12 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	029	0	2019	Oregon, Washington		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	030	0		29	10	S5820_030_0	1	1				05/24/2018	2019.01	05/24/2018 04:23:54 PM Central Daylight Time		05/30/2018 10:05:36 AM Central Daylight Time			06/01/2018 02:47:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	030	0	2019	Idaho, Utah		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	031	0		29	10	S5820_031_0	1	1				05/24/2018	2019.01	05/24/2018 04:24:27 PM Central Daylight Time		05/30/2018 10:05:58 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	031	0	2019	California		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	032	0		29	10	S5820_032_0	1	1				05/30/2018	2019.01	05/30/2018 09:39:17 AM Central Daylight Time		05/30/2018 10:06:22 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	032	0	2019	Hawaii		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)774-9679		(866)774-9679		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	033	0		29	10	S5820_033_0	1	1				05/24/2018	2019.01	05/24/2018 04:25:33 PM Central Daylight Time		05/30/2018 10:06:44 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	033	0	2019	Alaska		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)868-1394		(866)868-1394		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	034	0		29	10	S5820_034_0	1	1				05/24/2018	2019.01	05/24/2018 04:26:30 PM Central Daylight Time		05/30/2018 10:07:08 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	034	0	2019	American Samoa		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	035	0		29	10	S5820_035_0	1	1				05/24/2018	2019.01	05/24/2018 11:52:14 AM Central Daylight Time		05/30/2018 10:07:32 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	035	0	2019	Guam		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	036	0		29	10	S5820_036_0	1	1				05/24/2018	2019.01	05/24/2018 11:53:43 AM Central Daylight Time		05/30/2018 10:07:56 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	036	0	2019	Northern Mariana Islands		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	037	0		29	10	S5820_037_0	1	1				05/24/2018	2019.01	05/24/2018 11:56:49 AM Central Daylight Time		05/30/2018 10:08:20 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	037	0	2019	Puerto Rico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	038	0		29	10	S5820_038_0	1	1				05/24/2018	2019.01	05/24/2018 11:54:40 AM Central Daylight Time		05/30/2018 10:08:42 AM Central Daylight Time			06/01/2018 02:54:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	038	0	2019	US Virgin Islands		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	803	0		29	10	S5820_803_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:53 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	803	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	804	0		29	10	S5820_804_0	1	1				05/24/2018	2019.01	05/24/2018 04:31:57 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	804	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	807	0		29	10	S5820_807_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:01 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	807	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	808	0		29	10	S5820_808_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:05 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	808	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	810	0		29	10	S5820_810_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:12 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	810	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	811	0		29	10	S5820_811_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:17 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	811	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	812	0		29	10	S5820_812_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:25 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	812	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	813	0		29	10	S5820_813_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:29 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	813	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	814	0		29	10	S5820_814_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:34 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	814	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	815	0		29	10	S5820_815_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:38 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	815	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	816	0		29	10	S5820_816_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:42 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	816	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	817	0		29	10	S5820_817_0	1	1				05/24/2018	2019.01	05/24/2018 04:32:48 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	817	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	818	0		29	10	S5820_818_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:03 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	818	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	819	0		29	10	S5820_819_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:09 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	819	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	820	0		29	10	S5820_820_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:14 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	820	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	821	0		29	10	S5820_821_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:18 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	821	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	822	0		29	10	S5820_822_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:23 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	822	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	823	0		29	10	S5820_823_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:27 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	823	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	824	0		29	10	S5820_824_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:34 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	824	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	825	0		29	10	S5820_825_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:39 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	825	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	826	0		29	10	S5820_826_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:45 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	826	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	827	0		29	10	S5820_827_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:50 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	827	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	828	0		29	10	S5820_828_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:54 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	828	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	829	0		29	10	S5820_829_0	1	1				05/24/2018	2019.01	05/24/2018 04:33:59 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	829	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	830	0		29	10	S5820_830_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:04 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	830	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	831	0		29	10	S5820_831_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:09 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	831	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	832	0		29	10	S5820_832_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:13 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	832	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	833	0		29	10	S5820_833_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:18 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	833	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	834	0		29	10	S5820_834_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:23 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	834	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	835	0		29	10	S5820_835_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:27 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	835	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	836	0		29	10	S5820_836_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:32 PM Central Daylight Time					06/02/2018 03:21:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	836	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5857	802	0		29	10	S5857_802_0	6	1				05/30/2018	2019.01	05/30/2018 10:00:59 AM Eastern Daylight Time					06/04/2018 08:24:56 AM Eastern Daylight Time	PRIORITY HEALTH INSURANCE COMPANY	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Rx EG Non-Calendar Year (PDP)	10	29					S5857	802	0	2019	United States		1					2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5857	803	0		29	10	S5857_803_0	6	1				05/30/2018	2019.01	05/30/2018 10:01:07 AM Eastern Daylight Time					06/04/2018 08:24:56 AM Eastern Daylight Time	PRIORITY HEALTH INSURANCE COMPANY	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Rx EG Calendar Year (PDP)	10	29					S5857	803	0	2019	United States		1					2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5877	803	0		29	10	S5877_803_0	1	1				05/29/2018	2019.01	05/29/2018 12:56:12 PM Mountain Daylight Time					05/29/2018 12:56:47 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Alpine School District Retiree Plan (PDP)	10	29					S5877	803	0	2019	State of Utah and State of Idaho		1					2						http://www.express-scripts.com	https://medicare.emihealth.com/Formulary.aspx										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476																
S5877	804	0		29	10	S5877_804_0	1	1				05/29/2018	2019.01	05/29/2018 12:56:24 PM Mountain Daylight Time					05/29/2018 12:56:47 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Educators Mutual Retiree Plan (PDP)	10	29					S5877	804	0	2019	State of Utah and State of Idaho		1					2						http://www.express-scripts.com	https://medicare.emihealth.com/Formulary.aspx										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476																
S5884	001	0		29	10	S5884_001_0	4	1				05/25/2018	2019.01	05/25/2018 04:05:57 PM Eastern Daylight Time		07/17/2018 09:07:57 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	001	0	2019	States of Alabama and Tennessee		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	002	0		29	10	S5884_002_0	3	1				05/20/2018	2019.01	05/20/2018 12:53:56 PM Eastern Daylight Time		05/31/2018 10:51:32 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	002	0	2019	States of CT, MA, RI, VT		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	004	0		29	10	S5884_004_0	5	1				05/25/2018	2019.01	05/25/2018 04:08:08 PM Eastern Daylight Time		07/25/2018 11:27:33 AM Eastern Daylight Time			07/25/2018 01:01:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	004	0	2019	States of DC, DE, MD		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	005	0		29	10	S5884_005_0	4	1				05/20/2018	2019.01	05/20/2018 12:54:28 PM Eastern Daylight Time		07/17/2018 09:08:02 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	005	0	2019	States of Pennsylvania and West Virginia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	008	0		29	10	S5884_008_0	3	1				05/25/2018	2019.01	05/25/2018 04:09:21 PM Eastern Daylight Time		05/31/2018 10:53:28 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	008	0	2019	State of South Carolina		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	009	0		29	10	S5884_009_0	4	1				05/25/2018	2019.01	05/25/2018 04:10:58 PM Eastern Daylight Time		07/17/2018 09:08:07 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	009	0	2019	State of Georgia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	010	0		29	10	S5884_010_0	4	1				05/25/2018	2019.01	05/25/2018 04:12:04 PM Eastern Daylight Time		07/17/2018 09:08:12 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	010	0	2019	State of Florida		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	015	0		29	10	S5884_015_0	3	1				05/25/2018	2019.01	05/25/2018 04:13:46 PM Eastern Daylight Time		05/31/2018 10:55:22 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	015	0	2019	State of Illinois		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	019	0		29	10	S5884_019_0	4	1				05/25/2018	2019.01	05/25/2018 04:15:05 PM Eastern Daylight Time		07/17/2018 09:08:18 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	019	0	2019	State of Louisiana		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	020	0		29	10	S5884_020_0	4	1				05/25/2018	2019.01	05/25/2018 04:16:58 PM Eastern Daylight Time		07/17/2018 09:08:23 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	020	0	2019	State of Texas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	021	0		29	10	S5884_021_0	4	1				05/25/2018	2019.01	05/25/2018 04:17:59 PM Eastern Daylight Time		07/17/2018 09:08:28 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	021	0	2019	State of Oklahoma		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	022	0		29	10	S5884_022_0	4	1				05/25/2018	2019.01	05/25/2018 04:19:00 PM Eastern Daylight Time		07/17/2018 09:08:33 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	022	0	2019	State of Kansas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	024	0		29	10	S5884_024_0	3	1				05/25/2018	2019.01	05/25/2018 04:20:23 PM Eastern Daylight Time		05/31/2018 10:58:30 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	024	0	2019	State of New Mexico		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	028	0		29	10	S5884_028_0	3	1				05/20/2018	2019.01	05/20/2018 01:23:45 PM Eastern Daylight Time		05/31/2018 10:59:08 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	028	0	2019	States of Oregon and Washington		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	030	0		29	10	S5884_030_0	3	1				05/25/2018	2019.01	05/25/2018 04:21:43 PM Eastern Daylight Time		05/31/2018 10:59:46 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	030	0	2019	State of California		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	062	0		29	10	S5884_062_0	4	1				05/25/2018	2019.01	05/25/2018 04:23:18 PM Eastern Daylight Time		07/17/2018 09:08:38 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	062	0	2019	State of New Jersey		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	065	0		29	10	S5884_065_0	4	1				05/25/2018	2019.01	05/25/2018 04:25:23 PM Eastern Daylight Time		07/17/2018 09:08:43 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	065	0	2019	State of Virginia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	066	0		29	10	S5884_066_0	4	1				05/25/2018	2019.01	05/25/2018 04:29:53 PM Eastern Daylight Time		07/17/2018 09:08:48 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	066	0	2019	State of North Carolina		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	071	0		29	10	S5884_071_0	4	1				05/20/2018	2019.01	05/20/2018 01:26:09 PM Eastern Daylight Time		07/17/2018 09:08:52 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	071	0	2019	State of Michigan		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	072	0		29	10	S5884_072_0	3	1				05/20/2018	2019.01	05/20/2018 01:26:21 PM Eastern Daylight Time		05/31/2018 11:02:54 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	072	0	2019	State of Ohio		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	073	0		29	10	S5884_073_0	3	1				05/25/2018	2019.01	05/25/2018 04:31:11 PM Eastern Daylight Time		05/31/2018 11:03:32 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	073	0	2019	States of Indiana and Kentucky		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	074	0		29	10	S5884_074_0	4	1				05/25/2018	2019.01	05/25/2018 06:23:18 PM Eastern Daylight Time		07/17/2018 09:08:56 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	074	0	2019	State of Wisconsin		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	076	0		29	10	S5884_076_0	4	1				05/25/2018	2019.01	05/25/2018 06:24:25 PM Eastern Daylight Time		07/17/2018 09:09:01 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	076	0	2019	State of Missouri		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	077	0		29	10	S5884_077_0	4	1				05/25/2018	2019.01	05/25/2018 06:25:35 PM Eastern Daylight Time		07/17/2018 09:09:06 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	077	0	2019	State of Arkansas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	078	0		29	10	S5884_078_0	3	1				05/25/2018	2019.01	05/25/2018 06:26:32 PM Eastern Daylight Time		05/31/2018 11:06:04 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	078	0	2019	State of Mississippi		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	083	0		29	10	S5884_083_0	4	1				05/25/2018	2019.01	05/25/2018 06:27:23 PM Eastern Daylight Time		07/17/2018 09:09:12 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	083	0	2019	States of IA, MN, MT, ND, NE, SD, WY		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	085	0		29	10	S5884_085_0	4	1				05/25/2018	2019.01	05/25/2018 06:28:15 PM Eastern Daylight Time		07/17/2018 09:09:16 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	085	0	2019	State of Colorado		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	086	0		29	10	S5884_086_0	4	1				05/25/2018	2019.01	05/25/2018 06:29:09 PM Eastern Daylight Time		07/17/2018 09:09:22 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	086	0	2019	State of Arizona		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	087	0		29	10	S5884_087_0	5	1				05/25/2018	2019.01	05/25/2018 06:29:58 PM Eastern Daylight Time		07/25/2018 11:27:36 AM Eastern Daylight Time			07/25/2018 01:01:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	087	0	2019	State of Nevada		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	089	0		29	10	S5884_089_0	5	1				05/20/2018	2019.01	05/20/2018 01:33:49 PM Eastern Daylight Time		07/25/2018 11:27:40 AM Eastern Daylight Time			07/25/2018 01:01:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	089	0	2019	States of Idaho and Utah		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	092	0		29	10	S5884_092_0	3	1				05/25/2018	2019.01	05/25/2018 06:30:51 PM Eastern Daylight Time		05/31/2018 11:09:53 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	092	0	2019	States of Maine and New Hampshire		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	093	0		29	10	S5884_093_0	5	1				05/25/2018	2019.01	05/25/2018 06:31:48 PM Eastern Daylight Time		07/25/2018 11:27:44 AM Eastern Daylight Time			07/25/2018 01:01:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	093	0	2019	State of Hawaii		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	094	0		29	10	S5884_094_0	3	1				05/25/2018	2019.01	05/25/2018 06:32:42 PM Eastern Daylight Time		05/31/2018 11:11:11 AM Eastern Daylight Time			06/01/2018 10:06:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Enhanced (PDP)	10	29					S5884	094	0	2019	State of Alaska		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	101	0		29	10	S5884_101_0	4	1				05/25/2018	2019.01	05/25/2018 06:58:14 PM Eastern Daylight Time		07/17/2018 09:09:26 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	101	0	2019	States of Maine and New Hampshire		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	102	0		29	10	S5884_102_0	3	1				05/26/2018	2019.01	05/26/2018 08:48:31 AM Eastern Daylight Time		07/17/2018 09:09:30 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	102	0	2019	States of CT, MA, RI, VT		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	103	0		29	10	S5884_103_0	3	1				05/25/2018	2019.01	05/25/2018 06:58:30 PM Eastern Daylight Time		07/17/2018 09:09:35 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	103	0	2019	States of DC, DE, MD		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	104	0		29	10	S5884_104_0	3	1				05/25/2018	2019.01	05/25/2018 06:58:50 PM Eastern Daylight Time		07/17/2018 09:09:39 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	104	0	2019	States of Pennsylvania and West Virginia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	105	0		29	10	S5884_105_0	3	1				05/25/2018	2019.01	05/25/2018 06:59:00 PM Eastern Daylight Time		07/17/2018 09:09:43 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	105	0	2019	State of Florida		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	106	0		29	10	S5884_106_0	3	1				05/25/2018	2019.01	05/25/2018 06:59:10 PM Eastern Daylight Time		07/17/2018 09:09:46 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	106	0	2019	States of Alabama and Tennessee		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	107	0		29	10	S5884_107_0	3	1				05/25/2018	2019.01	05/25/2018 06:59:19 PM Eastern Daylight Time		07/17/2018 09:09:51 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	107	0	2019	State of Illinois		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	108	0		29	10	S5884_108_0	4	1				05/25/2018	2019.01	05/25/2018 06:59:29 PM Eastern Daylight Time		07/24/2018 01:15:31 PM Eastern Daylight Time			07/24/2018 02:16:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	108	0	2019	State of Louisiana		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	109	0		29	10	S5884_109_0	3	1				05/25/2018	2019.01	05/25/2018 06:59:39 PM Eastern Daylight Time		07/17/2018 09:10:00 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	109	0	2019	State of Kansas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	110	0		29	10	S5884_110_0	3	1				05/25/2018	2019.01	05/25/2018 06:59:48 PM Eastern Daylight Time		07/17/2018 09:10:04 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	110	0	2019	State of New Mexico		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	111	0		29	10	S5884_111_0	3	1				05/25/2018	2019.01	05/25/2018 07:00:01 PM Eastern Daylight Time		07/17/2018 09:10:09 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	111	0	2019	State of Colorado		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	112	0		29	10	S5884_112_0	3	1				05/25/2018	2019.01	05/25/2018 07:00:15 PM Eastern Daylight Time		07/17/2018 09:10:13 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	112	0	2019	State of Nevada		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	113	0		29	10	S5884_113_0	3	1				05/25/2018	2019.01	05/25/2018 07:00:24 PM Eastern Daylight Time		07/17/2018 09:10:19 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	113	0	2019	States of Oregon and Washington		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	114	0		29	10	S5884_114_0	3	1				05/25/2018	2019.01	05/25/2018 07:00:33 PM Eastern Daylight Time		07/17/2018 09:10:23 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	114	0	2019	State of California		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	115	0		29	10	S5884_115_0	2	1				05/25/2018	2019.01	05/25/2018 07:00:44 PM Eastern Daylight Time		05/31/2018 11:20:43 AM Eastern Daylight Time			06/01/2018 10:26:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	115	0	2019	State of Hawaii		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	116	0		29	10	S5884_116_0	4	1				05/26/2018	2019.01	05/26/2018 08:52:31 AM Eastern Daylight Time		07/23/2018 09:20:52 AM Eastern Daylight Time			07/25/2018 01:01:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	116	0	2019	State of Alaska		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	131	0		29	10	S5884_131_0	3	1				05/25/2018	2019.01	05/25/2018 07:00:56 PM Eastern Daylight Time		07/17/2018 09:10:32 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	131	0	2019	State of New Jersey		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	132	0		29	10	S5884_132_0	4	1				05/25/2018	2019.01	05/25/2018 07:01:08 PM Eastern Daylight Time		07/24/2018 01:15:35 PM Eastern Daylight Time			07/24/2018 02:16:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	132	0	2019	State of Virginia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	133	0		29	10	S5884_133_0	3	1				05/25/2018	2019.01	05/25/2018 07:01:19 PM Eastern Daylight Time		07/17/2018 09:10:41 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	133	0	2019	State of North Carolina		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	134	0		29	10	S5884_134_0	3	1				05/25/2018	2019.01	05/25/2018 07:01:29 PM Eastern Daylight Time		07/17/2018 09:10:45 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	134	0	2019	State of South Carolina		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	135	0		29	10	S5884_135_0	3	1				05/25/2018	2019.01	05/25/2018 07:01:42 PM Eastern Daylight Time		07/17/2018 09:10:49 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	135	0	2019	State of Georgia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	136	0		29	10	S5884_136_0	3	1				05/25/2018	2019.01	05/25/2018 07:01:52 PM Eastern Daylight Time		07/17/2018 09:10:55 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	136	0	2019	State of Michigan		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	137	0		29	10	S5884_137_0	3	1				05/25/2018	2019.01	05/25/2018 07:02:02 PM Eastern Daylight Time		07/17/2018 09:10:59 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	137	0	2019	State of Ohio		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	138	0		29	10	S5884_138_0	3	1				05/25/2018	2019.01	05/25/2018 07:02:13 PM Eastern Daylight Time		07/17/2018 09:11:04 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	138	0	2019	States of Indiana and Kentucky		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	139	0		29	10	S5884_139_0	3	1				05/25/2018	2019.01	05/25/2018 07:02:22 PM Eastern Daylight Time		07/17/2018 09:11:09 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	139	0	2019	State of Wisconsin		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	140	0		29	10	S5884_140_0	3	1				05/25/2018	2019.01	05/25/2018 07:02:33 PM Eastern Daylight Time		07/17/2018 09:11:13 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	140	0	2019	State of Missouri		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	141	0		29	10	S5884_141_0	3	1				05/25/2018	2019.01	05/25/2018 07:02:42 PM Eastern Daylight Time		07/17/2018 09:11:18 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	141	0	2019	State of Arkansas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	142	0		29	10	S5884_142_0	3	1				05/25/2018	2019.01	05/25/2018 07:02:53 PM Eastern Daylight Time		07/17/2018 09:11:22 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	142	0	2019	State of Mississippi		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	143	0		29	10	S5884_143_0	3	1				05/25/2018	2019.01	05/25/2018 07:03:05 PM Eastern Daylight Time		07/17/2018 09:11:26 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	143	0	2019	State of Texas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	144	0		29	10	S5884_144_0	3	1				05/25/2018	2019.01	05/25/2018 07:03:17 PM Eastern Daylight Time		07/17/2018 09:11:29 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	144	0	2019	State of Oklahoma		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	145	0		29	10	S5884_145_0	4	1				05/25/2018	2019.01	05/25/2018 07:03:31 PM Eastern Daylight Time		07/24/2018 01:15:39 PM Eastern Daylight Time			07/24/2018 02:16:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	145	0	2019	States of IA, MN, MT, ND, NE, SD, WY		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	146	0		29	10	S5884_146_0	4	1				05/25/2018	2019.01	05/25/2018 07:03:41 PM Eastern Daylight Time		07/24/2018 01:15:42 PM Eastern Daylight Time			07/24/2018 02:16:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	146	0	2019	State of Arizona		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	147	0		29	10	S5884_147_0	3	1				05/26/2018	2019.01	05/26/2018 08:50:38 AM Eastern Daylight Time		07/17/2018 09:11:41 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Preferred Rx Plan (PDP)	10	29					S5884	147	0	2019	States of Idaho and Utah		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	148	0		29	10	S5884_148_0	4	1				05/15/2018	2019.01	05/15/2018 08:18:08 AM Eastern Daylight Time		07/17/2018 09:11:45 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	148	0	2019	States of Maine and New Hampshire		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	149	0		29	10	S5884_149_0	3	1				05/15/2018	2019.01	05/15/2018 08:18:32 AM Eastern Daylight Time		07/17/2018 09:11:48 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	149	0	2019	States of CT, MA, RI, VT		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	150	0		29	10	S5884_150_0	2	1				05/15/2018	2019.01	05/15/2018 08:18:50 AM Eastern Daylight Time		05/31/2018 11:33:58 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	150	0	2019	State of New Jersey		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	151	0		29	10	S5884_151_0	3	1				05/15/2018	2019.01	05/15/2018 08:19:11 AM Eastern Daylight Time		07/17/2018 09:11:52 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	151	0	2019	States of DC, DE, MD		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	152	0		29	10	S5884_152_0	3	1				05/15/2018	2019.01	05/15/2018 08:19:28 AM Eastern Daylight Time		07/17/2018 09:11:56 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	152	0	2019	States of Pennsylvania and West Virginia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	153	0		29	10	S5884_153_0	2	1				05/15/2018	2019.01	05/15/2018 08:19:42 AM Eastern Daylight Time		05/31/2018 11:35:51 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	153	0	2019	State of Virginia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	154	0		29	10	S5884_154_0	3	1				05/15/2018	2019.01	05/15/2018 08:19:56 AM Eastern Daylight Time		07/17/2018 09:12:00 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	154	0	2019	State of North Carolina		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	155	0		29	10	S5884_155_0	3	1				05/15/2018	2019.01	05/15/2018 08:20:15 AM Eastern Daylight Time		07/17/2018 09:12:04 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	155	0	2019	State of South Carolina		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	156	0		29	10	S5884_156_0	3	1				05/15/2018	2019.01	05/15/2018 08:20:30 AM Eastern Daylight Time		07/17/2018 09:12:08 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	156	0	2019	State of Georgia		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	157	0		29	10	S5884_157_0	3	1				05/15/2018	2019.01	05/15/2018 08:20:44 AM Eastern Daylight Time		07/17/2018 09:12:12 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	157	0	2019	State of Florida		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	158	0		29	10	S5884_158_0	2	1				05/15/2018	2019.01	05/15/2018 08:20:58 AM Eastern Daylight Time		05/31/2018 11:38:59 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	158	0	2019	States of Alabama and Tennessee		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	159	0		29	10	S5884_159_0	3	1				05/15/2018	2019.01	05/15/2018 08:21:12 AM Eastern Daylight Time		07/17/2018 09:12:16 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	159	0	2019	State of Michigan		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	160	0		29	10	S5884_160_0	3	1				05/15/2018	2019.01	05/15/2018 08:21:27 AM Eastern Daylight Time		07/17/2018 09:12:20 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	160	0	2019	State of Ohio		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	161	0		29	10	S5884_161_0	2	1				05/15/2018	2019.01	05/15/2018 08:21:42 AM Eastern Daylight Time		05/31/2018 11:40:52 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	161	0	2019	States of Indiana and Kentucky		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	162	0		29	10	S5884_162_0	2	1				05/15/2018	2019.01	05/15/2018 07:33:04 PM Eastern Daylight Time		05/31/2018 11:41:30 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	162	0	2019	State of Wisconsin		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	163	0		29	10	S5884_163_0	3	1				05/15/2018	2019.01	05/15/2018 08:21:57 AM Eastern Daylight Time		07/17/2018 09:12:24 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	163	0	2019	State of Illinois		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	164	0		29	10	S5884_164_0	3	1				05/15/2018	2019.01	05/15/2018 08:22:13 AM Eastern Daylight Time		07/17/2018 09:12:28 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	164	0	2019	State of Missouri		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	165	0		29	10	S5884_165_0	3	1				05/15/2018	2019.01	05/15/2018 08:22:37 AM Eastern Daylight Time		07/17/2018 09:12:31 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	165	0	2019	State of Arkansas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	166	0		29	10	S5884_166_0	3	1				05/15/2018	2019.01	05/15/2018 08:22:51 AM Eastern Daylight Time		07/17/2018 09:12:37 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	166	0	2019	State of Mississippi		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	167	0		29	10	S5884_167_0	2	1				05/15/2018	2019.01	05/15/2018 08:23:04 AM Eastern Daylight Time		05/31/2018 11:44:40 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	167	0	2019	State of Louisiana		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	168	0		29	10	S5884_168_0	2	1				05/15/2018	2019.01	05/15/2018 08:23:18 AM Eastern Daylight Time		05/31/2018 11:45:17 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	168	0	2019	State of Texas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	169	0		29	10	S5884_169_0	2	1				05/15/2018	2019.01	05/15/2018 08:23:32 AM Eastern Daylight Time		05/31/2018 11:45:55 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	169	0	2019	State of Oklahoma		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	170	0		29	10	S5884_170_0	2	1				05/15/2018	2019.01	05/15/2018 08:24:05 AM Eastern Daylight Time		05/31/2018 11:46:32 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	170	0	2019	State of Kansas		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	171	0		29	10	S5884_171_0	3	1				05/15/2018	2019.01	05/15/2018 08:24:20 AM Eastern Daylight Time		07/17/2018 09:12:41 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	171	0	2019	States of IA, MN, MT, ND, NE, SD, WY		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	172	0		29	10	S5884_172_0	3	1				05/15/2018	2019.01	05/15/2018 08:24:36 AM Eastern Daylight Time		07/17/2018 09:12:45 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	172	0	2019	State of New Mexico		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	173	0		29	10	S5884_173_0	2	1				05/15/2018	2019.01	05/15/2018 08:24:56 AM Eastern Daylight Time		05/31/2018 11:48:26 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	173	0	2019	State of Colorado		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	174	0		29	10	S5884_174_0	3	1				05/15/2018	2019.01	05/15/2018 08:25:13 AM Eastern Daylight Time		07/17/2018 09:12:49 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	174	0	2019	State of Arizona		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	175	0		29	10	S5884_175_0	2	1				05/15/2018	2019.01	05/15/2018 08:25:27 AM Eastern Daylight Time		05/31/2018 11:49:41 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	175	0	2019	State of Nevada		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	176	0		29	10	S5884_176_0	3	1				05/15/2018	2019.01	05/15/2018 08:25:40 AM Eastern Daylight Time		07/17/2018 09:12:54 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	176	0	2019	States of Oregon and Washington		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	177	0		29	10	S5884_177_0	2	1				05/15/2018	2019.01	05/15/2018 08:25:54 AM Eastern Daylight Time		05/31/2018 11:50:57 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	177	0	2019	States of Idaho and Utah		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	178	0		29	10	S5884_178_0	2	1				05/15/2018	2019.01	05/15/2018 08:26:07 AM Eastern Daylight Time		05/31/2018 11:51:35 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	178	0	2019	State of California		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	179	0		29	10	S5884_179_0	3	1				06/01/2018	2019.01	06/01/2018 08:44:09 AM Eastern Daylight Time		05/31/2018 11:52:13 AM Eastern Daylight Time			06/01/2018 10:32:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	179	0	2019	State of Hawaii		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	180	0		29	10	S5884_180_0	3	1				05/15/2018	2019.01	05/15/2018 08:26:33 AM Eastern Daylight Time		07/17/2018 09:12:58 AM Eastern Daylight Time			07/17/2018 09:53:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Rx Plan (PDP)	10	29					S5884	180	0	2019	State of Alaska		2					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	834	0		29	10	S5884_834_0	2	1				05/17/2018	2019.01	05/17/2018 10:18:26 AM Eastern Daylight Time					05/31/2018 01:20:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5884	834	0	2019	All Regions		1					2						http://www.humana.com/Medicare/medicare_prescription_drugs/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-																
S5904	001	0		29	10	S5904_001_0	6	1				07/03/2018	2019.01	07/03/2018 10:23:32 AM Eastern Daylight Time		07/24/2018 11:24:19 AM Eastern Daylight Time			07/25/2018 09:05:23 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Premier Rx (PDP)	10	29					S5904	001	0	2019	State of Florida		2					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770																
S5904	002	0		29	10	S5904_002_0	6	1				07/03/2018	2019.01	07/03/2018 10:23:59 AM Eastern Daylight Time		07/11/2018 01:58:53 PM Eastern Daylight Time			07/12/2018 02:22:36 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Complete Rx (PDP)	10	29					S5904	002	0	2019	State of Florida		2					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770																
S5904	006	0		29	10	S5904_006_0	7	1				07/09/2018	2019.01	07/09/2018 04:15:58 PM Eastern Daylight Time		07/10/2018 04:23:28 PM Eastern Daylight Time			07/10/2018 04:26:05 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value Rx (PDP)	10	29					S5904	006	0	2019	State of Florida		2					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770																
S5904	801	0		29	10	S5904_801_0	5	1				06/01/2018	2019.01	06/01/2018 04:03:42 PM Eastern Daylight Time					06/04/2018 12:31:16 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group Rx (PDP)	10	29					S5904	801	0	2019	State of Florida with National Coverage		1					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770																
S5904	802	0		29	10	S5904_802_0	5	1				04/09/2018	2019.01	04/09/2018 01:52:36 PM Eastern Daylight Time					06/04/2018 12:31:16 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group Rx (PDP)	10	29					S5904	802	0	2019	State of Florida with National Coverage		1					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770																
S5916	001	0		29	10	S5916_001_0	7	1				07/02/2018	2019.01	07/02/2018 12:50:16 PM Mountain Daylight Time		05/31/2018 03:29:10 PM Mountain Daylight Time			07/03/2018 12:24:27 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script Basic (PDP)	10	29					S5916	001	0	2019	Region of Idaho and Utah		2					2						www.regence.com/medicare	www.regence.com/medicare										(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-																
S5916	002	0		29	10	S5916_002_0	7	1				07/02/2018	2019.01	07/02/2018 12:49:24 PM Mountain Daylight Time		05/31/2018 03:29:46 PM Mountain Daylight Time			07/03/2018 12:24:27 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script Enhanced (PDP)	10	29					S5916	002	0	2019	Region of Idaho and Utah		2					2						www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare									(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-																
S5916	802	0		29	10	S5916_802_0	1	1				05/08/2018	2019.01	05/08/2018 10:33:14 AM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script (PDP)	10	29					S5916	802	0	2019	Nationwide except territories		1					2						www.regence.com/medicare	www.regence.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5916	804	0		29	10	S5916_804_0	1	1				05/11/2018	2019.01	05/11/2018 01:08:29 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script 02 (PDP)	10	29					S5916	804	0	2019	Nationwide except Territories		1					2						www.regence.com/medicare	www.regence.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5916	805	0		29	10	S5916_805_0	1	1				05/11/2018	2019.01	05/11/2018 01:08:37 PM Mountain Daylight Time					06/05/2018 10:13:44 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script 03 (PDP)	10	29					S5916	805	0	2019	Nationwide except Territories		1					2						www.regence.com/medicare	www.regence.com/medicare										(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-																
S5921	348	0		29	10	S5921_348_0	1	1				05/24/2018	2019.01	05/24/2018 08:53:49 AM Central Daylight Time		05/30/2018 10:09:06 AM Central Daylight Time			06/01/2018 03:05:19 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	348	0	2019	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	349	0		29	10	S5921_349_0	2	1				05/24/2018	2019.01	05/24/2018 09:32:41 AM Central Daylight Time		06/04/2018 10:12:54 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	349	0	2019	New Jersey		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	350	0		29	10	S5921_350_0	2	1				05/24/2018	2019.01	05/24/2018 09:51:56 AM Central Daylight Time		06/04/2018 10:13:18 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	350	0	2019	Delaware, Maryland and Washington D.C.		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	351	0		29	10	S5921_351_0	2	1				05/24/2018	2019.01	05/24/2018 08:57:25 AM Central Daylight Time		06/04/2018 10:13:42 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	351	0	2019	Pennsylvania and West Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	352	0		29	10	S5921_352_0	4	1				05/24/2018	2019.01	05/24/2018 09:56:40 AM Central Daylight Time		07/23/2018 02:10:46 PM Central Daylight Time			07/24/2018 10:06:04 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	352	0	2019	Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	353	0		29	10	S5921_353_0	2	1				05/24/2018	2019.01	05/24/2018 09:39:43 AM Central Daylight Time		06/04/2018 10:14:28 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	353	0	2019	North Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	354	0		29	10	S5921_354_0	2	1				05/24/2018	2019.01	05/24/2018 10:06:00 AM Central Daylight Time		06/04/2018 10:14:52 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	354	0	2019	South Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	355	0		29	10	S5921_355_0	2	1				05/24/2018	2019.01	05/24/2018 10:09:38 AM Central Daylight Time		06/04/2018 10:15:14 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	355	0	2019	Georgia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	356	0		29	10	S5921_356_0	3	1				05/24/2018	2019.01	05/24/2018 10:14:17 AM Central Daylight Time		06/04/2018 10:15:38 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	356	0	2019	Florida		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	357	0		29	10	S5921_357_0	2	1				05/24/2018	2019.01	05/24/2018 08:58:51 AM Central Daylight Time		06/04/2018 10:16:02 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	357	0	2019	Alabama and Tennessee		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	358	0		29	10	S5921_358_0	1	1				05/24/2018	2019.01	05/24/2018 11:46:38 AM Central Daylight Time		05/30/2018 10:12:56 AM Central Daylight Time			06/01/2018 03:05:19 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	358	0	2019	Michigan		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	359	0		29	10	S5921_359_0	2	1				05/24/2018	2019.01	05/24/2018 09:57:53 AM Central Daylight Time		06/04/2018 10:16:24 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	359	0	2019	Ohio		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	360	0		29	10	S5921_360_0	2	1				05/24/2018	2019.01	05/24/2018 09:03:11 AM Central Daylight Time		06/04/2018 10:16:48 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	360	0	2019	Indiana and Kentucky		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	361	0		29	10	S5921_361_0	1	1				05/24/2018	2019.01	05/24/2018 09:59:31 AM Central Daylight Time		05/30/2018 10:14:04 AM Central Daylight Time			06/01/2018 03:05:19 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	361	0	2019	Wisconsin		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	362	0		29	10	S5921_362_0	2	1				05/24/2018	2019.01	05/24/2018 10:17:04 AM Central Daylight Time		06/04/2018 10:17:12 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	362	0	2019	Illinois		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	363	0		29	10	S5921_363_0	2	1				05/24/2018	2019.01	05/24/2018 10:22:10 AM Central Daylight Time		06/04/2018 10:17:34 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	363	0	2019	Missouri		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	364	0		29	10	S5921_364_0	1	1				05/24/2018	2019.01	05/24/2018 09:41:01 AM Central Daylight Time		05/30/2018 10:15:18 AM Central Daylight Time			06/01/2018 03:16:24 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	364	0	2019	Arkansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	365	0		29	10	S5921_365_0	2	1				05/24/2018	2019.01	05/24/2018 10:00:26 AM Central Daylight Time		06/04/2018 10:17:58 AM Central Daylight Time			06/04/2018 12:52:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	365	0	2019	Mississippi		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	366	0		29	10	S5921_366_0	4	1				05/24/2018	2019.01	05/24/2018 09:06:45 AM Central Daylight Time		07/23/2018 02:11:06 PM Central Daylight Time			07/24/2018 10:06:04 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	366	0	2019	Louisiana		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	367	0		29	10	S5921_367_0	2	1				05/24/2018	2019.01	05/24/2018 10:26:16 AM Central Daylight Time		06/04/2018 10:18:44 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	367	0	2019	Texas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	368	0		29	10	S5921_368_0	3	1				05/24/2018	2019.01	05/24/2018 11:47:46 AM Central Daylight Time		06/04/2018 01:47:16 PM Central Daylight Time			06/04/2018 03:37:44 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	368	0	2019	Oklahoma		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	369	0		29	10	S5921_369_0	1	1				05/24/2018	2019.01	05/24/2018 10:01:08 AM Central Daylight Time		05/30/2018 10:17:12 AM Central Daylight Time			06/01/2018 03:16:24 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	369	0	2019	Kansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	370	0		29	10	S5921_370_0	2	1				05/24/2018	2019.01	05/24/2018 09:41:56 AM Central Daylight Time		05/30/2018 10:17:36 AM Central Daylight Time			06/01/2018 04:40:43 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	370	0	2019	IA, MN, MT, ND, NE, SD, WY		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	371	0		29	10	S5921_371_0	1	1				05/24/2018	2019.01	05/24/2018 10:01:57 AM Central Daylight Time		05/30/2018 10:18:04 AM Central Daylight Time			06/01/2018 03:16:24 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	371	0	2019	New Mexico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	372	0		29	10	S5921_372_0	2	1				05/24/2018	2019.01	05/24/2018 10:33:15 AM Central Daylight Time		06/04/2018 10:19:30 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	372	0	2019	Colorado		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	373	0		29	10	S5921_373_0	2	1				05/24/2018	2019.01	05/24/2018 09:42:38 AM Central Daylight Time		06/04/2018 10:19:52 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	373	0	2019	Nevada		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	374	0		29	10	S5921_374_0	2	1				05/24/2018	2019.01	05/24/2018 09:43:25 AM Central Daylight Time		06/04/2018 10:20:16 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	374	0	2019	Oregon and Washington		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	375	0		29	10	S5921_375_0	2	1				05/24/2018	2019.01	05/24/2018 09:44:08 AM Central Daylight Time		06/04/2018 10:20:40 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	375	0	2019	Idaho and Utah		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	376	0		29	10	S5921_376_0	2	1				05/24/2018	2019.01	05/24/2018 11:48:56 AM Central Daylight Time		06/04/2018 10:21:02 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	376	0	2019	California		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	377	0		29	10	S5921_377_0	1	1				05/24/2018	2019.01	05/24/2018 10:40:34 AM Central Daylight Time		05/30/2018 10:20:28 AM Central Daylight Time			06/01/2018 03:16:24 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	377	0	2019	Alaska		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)868-1394		(866)868-1394		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	378	0		29	10	S5921_378_0	1	1				05/24/2018	2019.01	05/24/2018 09:45:22 AM Central Daylight Time		05/30/2018 10:20:54 AM Central Daylight Time			06/01/2018 03:46:23 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	378	0	2019	Maine and New Hampshire		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	379	0		29	10	S5921_379_0	1	1				05/24/2018	2019.01	05/24/2018 10:44:53 AM Central Daylight Time		05/30/2018 10:21:18 AM Central Daylight Time			06/01/2018 03:46:23 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	379	0	2019	New York		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	380	0		29	10	S5921_380_0	3	1				05/24/2018	2019.01	05/24/2018 10:49:19 AM Central Daylight Time		05/30/2018 10:21:42 AM Central Daylight Time			06/01/2018 05:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	380	0	2019	Arizona		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	381	0		29	10	S5921_381_0	2	1				05/24/2018	2019.01	05/24/2018 10:53:41 AM Central Daylight Time		06/04/2018 10:21:26 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	381	0	2019	Hawaii		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)774-9679		(866)774-9679		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	382	0		29	10	S5921_382_0	2	1				05/24/2018	2019.01	05/24/2018 04:27:48 PM Central Daylight Time		06/04/2018 10:21:48 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	382	0	2019	New York		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	383	0		29	10	S5921_383_0	2	1				05/24/2018	2019.01	05/24/2018 11:16:58 AM Central Daylight Time		06/04/2018 10:22:12 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	383	0	2019	Florida		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	384	0		29	10	S5921_384_0	1	1				05/24/2018	2019.01	05/24/2018 11:18:58 AM Central Daylight Time		05/30/2018 10:23:18 AM Central Daylight Time			06/01/2018 03:46:23 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	384	0	2019	Northern New England		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	385	0		29	10	S5921_385_0	2	1				05/24/2018	2019.01	05/24/2018 11:21:00 AM Central Daylight Time		06/04/2018 10:22:34 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	385	0	2019	Central New England		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	386	0		29	10	S5921_386_0	1	1				05/24/2018	2019.01	05/24/2018 11:21:37 AM Central Daylight Time		05/30/2018 10:24:08 AM Central Daylight Time			06/01/2018 03:46:23 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	386	0	2019	New Jersey		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	387	0		29	10	S5921_387_0	1	1				05/24/2018	2019.01	05/24/2018 11:22:15 AM Central Daylight Time		05/30/2018 10:24:32 AM Central Daylight Time			06/01/2018 03:46:23 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	387	0	2019	Mid-Atlantic		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	388	0		29	10	S5921_388_0	2	1				05/24/2018	2019.01	05/24/2018 11:23:07 AM Central Daylight Time		06/04/2018 10:22:58 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	388	0	2019	Pennsylvania and West Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	389	0		29	10	S5921_389_0	1	1				05/24/2018	2019.01	05/24/2018 11:23:48 AM Central Daylight Time		05/30/2018 10:25:18 AM Central Daylight Time			06/01/2018 03:46:23 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	389	0	2019	Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	390	0		29	10	S5921_390_0	2	1				05/24/2018	2019.01	05/24/2018 11:24:29 AM Central Daylight Time		06/04/2018 10:23:20 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	390	0	2019	North Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	391	0		29	10	S5921_391_0	2	1				05/24/2018	2019.01	05/24/2018 11:25:19 AM Central Daylight Time		06/04/2018 10:23:44 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	391	0	2019	South Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	392	0		29	10	S5921_392_0	2	1				05/24/2018	2019.01	05/24/2018 11:26:30 AM Central Daylight Time		06/04/2018 10:24:06 AM Central Daylight Time			06/04/2018 01:08:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	392	0	2019	Georgia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	393	0		29	10	S5921_393_0	3	1				05/24/2018	2019.01	05/24/2018 11:27:11 AM Central Daylight Time		06/04/2018 02:06:56 PM Central Daylight Time			06/04/2018 03:37:44 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	393	0	2019	Alabama and Tennessee		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	394	0		29	10	S5921_394_0	1	1				05/24/2018	2019.01	05/24/2018 11:28:06 AM Central Daylight Time		05/30/2018 10:27:22 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	394	0	2019	Michigan		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	395	0		29	10	S5921_395_0	2	1				05/24/2018	2019.01	05/24/2018 11:28:51 AM Central Daylight Time		06/04/2018 10:24:52 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	395	0	2019	Ohio		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	396	0		29	10	S5921_396_0	1	1				05/24/2018	2019.01	05/24/2018 11:29:56 AM Central Daylight Time		05/30/2018 10:28:10 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	396	0	2019	Indiana and Kentucky		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	397	0		29	10	S5921_397_0	1	1				05/24/2018	2019.01	05/24/2018 11:30:37 AM Central Daylight Time		05/30/2018 10:28:32 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	397	0	2019	Wisconsin		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	398	0		29	10	S5921_398_0	1	1				05/24/2018	2019.01	05/24/2018 11:31:22 AM Central Daylight Time		05/30/2018 10:28:56 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	398	0	2019	Illinois		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	399	0		29	10	S5921_399_0	2	1				05/24/2018	2019.01	05/24/2018 11:32:01 AM Central Daylight Time		06/04/2018 10:25:14 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	399	0	2019	Missouri		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	400	0		29	10	S5921_400_0	2	1				05/24/2018	2019.01	05/24/2018 04:28:55 PM Central Daylight Time		06/04/2018 10:25:38 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	400	0	2019	Arkansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	401	0		29	10	S5921_401_0	2	1				05/24/2018	2019.01	05/24/2018 11:32:47 AM Central Daylight Time		06/04/2018 10:26:00 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	401	0	2019	Mississippi		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	402	0		29	10	S5921_402_0	2	1				05/24/2018	2019.01	05/24/2018 11:33:28 AM Central Daylight Time		06/04/2018 10:26:24 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	402	0	2019	Louisiana		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	403	0		29	10	S5921_403_0	1	1				05/24/2018	2019.01	05/24/2018 11:34:10 AM Central Daylight Time		05/30/2018 10:30:58 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	403	0	2019	Texas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	404	0		29	10	S5921_404_0	1	1				05/24/2018	2019.01	05/24/2018 11:34:46 AM Central Daylight Time		05/30/2018 10:31:22 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	404	0	2019	Oklahoma		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	405	0		29	10	S5921_405_0	2	1				05/24/2018	2019.01	05/24/2018 11:35:22 AM Central Daylight Time		06/04/2018 10:26:46 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	405	0	2019	Kansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	406	0		29	10	S5921_406_0	1	1				05/24/2018	2019.01	05/24/2018 11:36:15 AM Central Daylight Time		05/30/2018 10:32:12 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	406	0	2019	Upper Midwest and Northern Plains		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	407	0		29	10	S5921_407_0	2	1				05/24/2018	2019.01	05/24/2018 11:36:52 AM Central Daylight Time		06/04/2018 10:27:08 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	407	0	2019	New Mexico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	408	0		29	10	S5921_408_0	1	1				05/24/2018	2019.01	05/24/2018 11:37:35 AM Central Daylight Time		05/30/2018 10:33:00 AM Central Daylight Time			06/01/2018 04:02:52 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	408	0	2019	Colorado		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	409	0		29	10	S5921_409_0	1	1				05/24/2018	2019.01	05/24/2018 11:38:31 AM Central Daylight Time		05/30/2018 10:33:22 AM Central Daylight Time			06/01/2018 04:10:22 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	409	0	2019	Arizona		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	410	0		29	10	S5921_410_0	1	1				05/24/2018	2019.01	05/24/2018 11:39:14 AM Central Daylight Time		05/30/2018 10:33:46 AM Central Daylight Time			06/01/2018 04:10:22 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	410	0	2019	Nevada		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	411	0		29	10	S5921_411_0	2	1				05/24/2018	2019.01	05/24/2018 11:39:58 AM Central Daylight Time		06/04/2018 10:27:32 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	411	0	2019	Oregon and Washington		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	412	0		29	10	S5921_412_0	1	1				05/24/2018	2019.01	05/24/2018 11:40:42 AM Central Daylight Time		05/30/2018 10:34:32 AM Central Daylight Time			06/01/2018 04:10:22 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	412	0	2019	Idaho and Utah		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	413	0		29	10	S5921_413_0	1	1				05/24/2018	2019.01	05/24/2018 11:41:37 AM Central Daylight Time		05/30/2018 10:34:54 AM Central Daylight Time			06/01/2018 04:10:22 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	413	0	2019	California		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	414	0		29	10	S5921_414_0	1	1				05/24/2018	2019.01	05/24/2018 04:30:03 PM Central Daylight Time		05/30/2018 10:35:18 AM Central Daylight Time			06/01/2018 04:10:22 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	414	0	2019	Hawaii		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)774-9679		(866)774-9679		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	415	0		29	10	S5921_415_0	2	1				05/24/2018	2019.01	05/24/2018 11:42:32 AM Central Daylight Time		06/04/2018 10:27:54 AM Central Daylight Time			06/04/2018 01:19:54 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	415	0	2019	Alaska		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)868-1394		(866)868-1394		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	802	0		29	10	S5921_802_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:42 PM Central Daylight Time					06/02/2018 03:25:13 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	802	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5921	837	0		29	10	S5921_837_0	1	1				05/24/2018	2019.01	05/24/2018 04:34:46 PM Central Daylight Time					06/02/2018 03:25:13 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	837	0	2019	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5953	001	0		29	10	S5953_001_0	5	1				07/06/2018	2019.01	07/06/2018 03:30:15 PM Eastern Daylight Time		06/20/2018 09:39:27 AM Eastern Daylight Time			07/06/2018 03:50:43 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	BlueCross Rx Value (PDP)	10	29					S5953	001	0	2019	South Carolina		2					2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	002	0		29	10	S5953_002_0	4	1				07/02/2018	2019.01	07/02/2018 12:14:29 PM Eastern Daylight Time		06/20/2018 09:40:05 AM Eastern Daylight Time			07/03/2018 11:16:44 AM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	BlueCross Rx Plus (PDP)	10	29					S5953	002	0	2019	South Carolina		2					2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	801	0		29	10	S5953_801_0	1	1				05/04/2018	2019.01	05/04/2018 12:19:11 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	Group Blue Rx Plus (PDP)	10	29					S5953	801	0	2019	South Carolina		1					2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	802	0		29	10	S5953_802_0	1	1				05/04/2018	2019.01	05/04/2018 12:20:04 PM Eastern Daylight Time					06/01/2018 07:07:57 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx19	Group Blue Rx Plus (PDP)	10	29					S5953	802	0	2019	South Carolina		1					2						www.scbluesmedadvantage.com/marx19	www.scbluesmedadvantage.com/marx19										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5960	801	0		29	10	S5960_801_0	2	1				06/01/2018	2019.01	06/01/2018 07:06:06 AM Eastern Daylight Time					06/01/2018 07:06:41 AM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	www.unicare.com/shop	MedicareRx Rewards (PDP)	10	29					S5960	801	0	2019	All States (Nationwide)		1					2						www.unicare.com/medicare	www.unicare.com/medicare										(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5960	803	0		29	10	S5960_803_0	2	1				06/01/2018	2019.01	06/01/2018 07:06:21 AM Eastern Daylight Time					06/01/2018 07:06:41 AM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	www.unicare.com/shop	MedicareRx Rewards (PDP)	10	29					S5960	803	0	2019	All States (Nationwide)		1					2						www.unicare.com/medicare	www.unicare.com/medicare										(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5966	803	0		29	10	S5966_803_0	1	1				05/11/2018	2019.01	05/11/2018 09:16:23 AM Eastern Daylight Time					05/25/2018 03:20:44 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	803	0	2019	United States		1					2						www.emblemhealth.com	www.emblemhealth.com										(800)585-5786		(800)585-5786		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-																
S5966	804	0		29	10	S5966_804_0	1	1				05/08/2018	2019.01	05/08/2018 11:23:54 AM Eastern Daylight Time					05/25/2018 03:20:44 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	804	0	2019	United States		1					2						www.emblemhealth.com	www.emblemhealth.com										(800)585-5786		(800)585-5786		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-																
S5975	801	0		29	10	S5975_801_0	2	1				06/04/2018	2019.01	06/04/2018 02:15:14 PM Pacific Daylight Time					06/04/2018 02:59:39 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	PERS Moda Health Rx (PDP)	10	29					S5975	801	0	2019	National		1					2						www.modahealth.com/medicare	www.modahealth.com/medicare										(888)786-7509		(503)265-4709		(888)786-7509		(503)265-4709										(711)-		(711)-		(711)-		(711)-																
S5975	806	0		29	10	S5975_806_0	1	1				05/22/2018	2019.01	05/22/2018 05:54:19 AM Pacific Daylight Time					06/02/2018 02:43:09 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Rx (PDP)	10	29					S5975	806	0	2019	State of Alaska		1					2						www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare									(844)721-4936		(503)265-4709		(844)721-4936		(503)265-2975										(711)-		(711)-		(711)-		(711)-																
S5983	004	0		29	10	S5983_004_0	1	1				06/01/2018	2019.01	06/01/2018 02:24:35 PM Eastern Daylight Time		06/04/2018 08:50:06 AM Eastern Daylight Time			06/04/2018 01:40:43 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5983	004	0	2019	State of New York		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5983	006	0		29	10	S5983_006_0	3	1				07/16/2018	2019.01	07/16/2018 10:49:28 AM Eastern Daylight Time		07/11/2018 02:03:36 PM Eastern Daylight Time			07/18/2018 09:29:36 AM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5983	006	0	2019	State of New York		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5983	007	0		29	10	S5983_007_0	1	1				06/04/2018	2019.01	06/04/2018 09:01:18 AM Eastern Daylight Time		06/04/2018 08:53:18 AM Eastern Daylight Time			06/04/2018 02:12:13 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5983	007	0	2019	State of New York		2					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5983	805	0		29	10	S5983_805_0	1	1				06/04/2018	2019.01	06/04/2018 02:15:23 PM Eastern Daylight Time					06/04/2018 02:17:06 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5983	805	0	2019	Premier Performance Closed 5 Tier - Calendar		1					2						www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com										(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5993	001	0		29	10	S5993_001_0	2	1				05/30/2018	2019.01	05/30/2018 01:45:11 PM Eastern Daylight Time		05/31/2018 03:56:33 PM Eastern Daylight Time			05/31/2018 03:59:22 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com/Medicare	Horizon Medicare Blue Rx Standard (PDP)	10	29					S5993	001	0	2019	New Jersey		2					2						http://www.horizonblue.com/pdp-pharmacy-search	http://www.horizonblue.com/pdp-drug-search										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	003	0		29	10	S5993_003_0	2	1				05/30/2018	2019.01	05/30/2018 01:44:45 PM Eastern Daylight Time		05/31/2018 03:57:31 PM Eastern Daylight Time			05/31/2018 03:59:22 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com/Medicare	Horizon Medicare Blue Rx Enhanced (PDP)	10	29					S5993	003	0	2019	New Jersey		2					2						http://www.horizonblue.com/pdp-pharmacy-search	http://www.horizonblue.com/pdp-drug-search										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	801	0		29	10	S5993_801_0	1	1				05/09/2018	2019.01	05/09/2018 09:04:17 AM Eastern Daylight Time					05/16/2018 05:22:39 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group Rx (PDP)	10	29					S5993	801	0	2019	National		1					2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	804	0		29	10	S5993_804_0	1	1				05/09/2018	2019.01	05/09/2018 09:04:08 AM Eastern Daylight Time					05/16/2018 05:22:39 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group RX Plus (PDP)	10	29					S5993	804	0	2019	National		1					2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	805	0		29	10	S5993_805_0	3	1				05/09/2018	2019.01	05/09/2018 09:03:57 AM Eastern Daylight Time					05/16/2018 05:22:39 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group Rx Value (PDP)	10	29					S5993	805	0	2019	National		1					2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S6506	001	0		29	10	S6506_001_0	2	1				06/02/2018	2019.01	06/02/2018 09:34:47 PM Central Daylight Time		06/02/2018 10:46:19 PM Central Daylight Time			06/02/2018 11:40:37 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Value (PDP)	10	29					S6506	001	0	2019	Arizona		2					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6506	002	0		29	10	S6506_002_0	2	1				06/02/2018	2019.01	06/02/2018 09:45:51 PM Central Daylight Time		06/02/2018 10:46:19 PM Central Daylight Time			06/02/2018 11:40:37 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Enhanced (PDP)	10	29					S6506	002	0	2019	Arizona		2					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6506	003	0		29	10	S6506_003_0	2	1				06/02/2018	2019.01	06/02/2018 09:50:04 PM Central Daylight Time		06/02/2018 10:46:18 PM Central Daylight Time			06/02/2018 11:40:37 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Essential (PDP)	10	29					S6506	003	0	2019	Arizona		2					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6506	801	0		29	10	S6506_801_0	1	1				04/16/2018	2019.01	04/16/2018 10:57:25 AM Central Daylight Time					05/31/2018 02:23:48 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx for Groups (PDP)	10	29					S6506	801	0	2019	Nationwide		1					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(877)560-8058		(877)560-8058		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6875	801	0		29	10	S6875_801_0	1	1				05/31/2018	2019.01	05/31/2018 03:25:55 PM Eastern Daylight Time					06/02/2018 09:15:02 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Select Option	http://www.ibxmedicare.com	Select Option Rx Group Option I CY (PDP)	10	29					S6875	801	0	2019	National		1					2						http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(888)678-7009		(888)678-7009										(711)-		(711)-		(711)-		(711)-																
S6875	802	0		29	10	S6875_802_0	1	1				05/18/2018	2019.01	05/18/2018 08:31:21 AM Eastern Daylight Time					06/02/2018 09:16:42 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Select Option	http://www.ibxmedicare.com	Select Option Rx Group Option I Non-CY (PDP)	10	29					S6875	802	0	2019	National		1					2						http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(888)678-7009		(888)678-7009										(711)-		(711)-		(711)-		(711)-																
S6986	001	0		29	10	S6986_001_0	1	1				06/02/2018	2019.01	06/02/2018 10:05:48 PM Central Daylight Time		06/02/2018 06:08:25 PM Central Daylight Time			06/03/2018 12:48:28 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	ScriptWell Standard (PDP)	10	29					S6986	001	0	2019	Michigan		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	002	0		29	10	S6986_002_0	1	1				06/02/2018	2019.01	06/02/2018 10:07:22 PM Central Daylight Time		06/02/2018 06:08:26 PM Central Daylight Time			06/03/2018 12:48:28 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	Basic Blue Rx Standard (PDP)	10	29					S6986	002	0	2019	North Carolina		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	003	0		29	10	S6986_003_0	1	1				06/02/2018	2019.01	06/02/2018 10:09:12 PM Central Daylight Time		06/02/2018 06:08:26 PM Central Daylight Time			06/03/2018 12:48:28 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	Basic Blue Rx Standard (PDP)	10	29					S6986	003	0	2019	Pennsylvania and West Virginia		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	004	0		29	10	S6986_004_0	1	1				06/02/2018	2019.01	06/02/2018 10:11:37 PM Central Daylight Time		06/02/2018 06:08:27 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	Basic Blue Rx Standard (PDP)	10	29					S6986	004	0	2019	Louisiana		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	006	0		29	10	S6986_006_0	1	1				06/02/2018	2019.01	06/02/2018 10:14:44 PM Central Daylight Time		06/02/2018 06:08:27 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	ScriptWell Standard (PDP)	10	29					S6986	006	0	2019	California		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	007	0		29	10	S6986_007_0	1	1				06/02/2018	2019.01	06/02/2018 10:16:29 PM Central Daylight Time		06/02/2018 10:22:13 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	ScriptWell Standard (PDP)	10	29					S6986	007	0	2019	States of IA, MN, MT, ND, NE, SD and WY		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	008	0		29	10	S6986_008_0	1	1				06/02/2018	2019.01	06/02/2018 10:24:49 PM Central Daylight Time		06/02/2018 06:08:27 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	ScriptWell Value (PDP)	10	29					S6986	008	0	2019	Michigan		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	009	0		29	10	S6986_009_0	1	1				06/02/2018	2019.01	06/02/2018 10:30:19 PM Central Daylight Time		06/02/2018 06:08:28 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	Basic Blue Rx Value (PDP)	10	29					S6986	009	0	2019	North Carolina		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	010	0		29	10	S6986_010_0	1	1				06/02/2018	2019.01	06/02/2018 10:32:47 PM Central Daylight Time		06/02/2018 06:08:28 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	Basic Blue Rx Value (PDP)	10	29					S6986	010	0	2019	Pennsylvania and West Virginia		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	011	0		29	10	S6986_011_0	1	1				06/02/2018	2019.01	06/02/2018 10:32:47 PM Central Daylight Time		06/02/2018 06:08:28 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	Basic Blue Rx Value (PDP)	10	29					S6986	011	0	2019	Louisiana		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	012	0		29	10	S6986_012_0	1	1				06/02/2018	2019.01	06/02/2018 10:35:15 PM Central Daylight Time		06/02/2018 06:08:29 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	ScriptWell Value (PDP)	10	29					S6986	012	0	2019	California		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	013	0		29	10	S6986_013_0	1	1				06/02/2018	2019.01	06/02/2018 10:35:47 PM Central Daylight Time		06/02/2018 10:22:19 PM Central Daylight Time			06/03/2018 12:57:30 AM Central Daylight Time	MII LIFE, INC.	MII Life, Inc.	www.basicbluerx.com	ScriptWell Value (PDP)	10	29					S6986	013	0	2019	States of IA, MN, MT, ND, NE, SD and WY		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S7126	001	0		29	10	S7126_001_0	2	1				06/04/2018	2019.01	06/04/2018 12:44:58 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	001	0	2019	Northern New England		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	002	0		29	10	S7126_002_0	1	1				05/26/2018	2019.01	05/26/2018 09:02:01 AM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	002	0	2019	Central New England		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	003	0		29	10	S7126_003_0	1	1				05/25/2018	2019.01	05/25/2018 02:22:07 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	003	0	2019	State of New Jersey		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	004	0		29	10	S7126_004_0	1	1				05/25/2018	2019.01	05/25/2018 02:26:55 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	004	0	2019	Mid-Atlantic		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	005	0		29	10	S7126_005_0	1	1				05/25/2018	2019.01	05/25/2018 02:30:18 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	005	0	2019	States of Pennsylvania and West Virginia		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	006	0		29	10	S7126_006_0	1	1				05/25/2018	2019.01	05/25/2018 02:07:39 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	006	0	2019	State of Virginia		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	007	0		29	10	S7126_007_0	1	1				05/25/2018	2019.01	05/25/2018 02:34:42 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	007	0	2019	State of North Carolina		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	008	0		29	10	S7126_008_0	1	1				05/25/2018	2019.01	05/25/2018 02:38:16 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	008	0	2019	State of South Carolina		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	009	0		29	10	S7126_009_0	1	1				05/25/2018	2019.01	05/25/2018 02:42:39 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	009	0	2019	State of Georgia		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	010	0		29	10	S7126_010_0	1	1				05/25/2018	2019.01	05/25/2018 02:45:51 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	010	0	2019	State of Florida		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	011	0		29	10	S7126_011_0	1	1				05/25/2018	2019.01	05/25/2018 02:49:41 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	011	0	2019	States of Alabama and Tennessee		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	012	0		29	10	S7126_012_0	1	1				05/25/2018	2019.01	05/25/2018 12:06:12 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	012	0	2019	State of Michigan		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	013	0		29	10	S7126_013_0	1	1				05/25/2018	2019.01	05/25/2018 02:52:52 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	013	0	2019	State of Ohio		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	014	0		29	10	S7126_014_0	1	1				05/25/2018	2019.01	05/25/2018 02:58:02 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	014	0	2019	States of Indiana and Kentucky		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	015	0		29	10	S7126_015_0	1	1				05/25/2018	2019.01	05/25/2018 02:59:42 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	015	0	2019	State of Wisconsin		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	016	0		29	10	S7126_016_0	1	1				05/25/2018	2019.01	05/25/2018 03:04:33 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	016	0	2019	State of Illinois		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	017	0		29	10	S7126_017_0	1	1				05/25/2018	2019.01	05/25/2018 12:19:30 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	017	0	2019	State of Missouri		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	018	0		29	10	S7126_018_0	1	1				05/25/2018	2019.01	05/25/2018 12:27:38 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	018	0	2019	State of Arkansas		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	019	0		29	10	S7126_019_0	1	1				05/25/2018	2019.01	05/25/2018 12:52:47 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	019	0	2019	State of Mississippi		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	020	0		29	10	S7126_020_0	1	1				05/25/2018	2019.01	05/25/2018 12:55:44 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	020	0	2019	State of Louisiana		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	021	0		29	10	S7126_021_0	1	1				05/25/2018	2019.01	05/25/2018 03:09:00 PM Eastern Daylight Time		06/04/2018 12:16:55 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	021	0	2019	State of Texas		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	022	0		29	10	S7126_022_0	1	1				05/25/2018	2019.01	05/25/2018 01:08:48 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	022	0	2019	State of Oklahoma		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	023	0		29	10	S7126_023_0	1	1				05/25/2018	2019.01	05/25/2018 01:20:34 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	023	0	2019	State of Kansas		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	024	0		29	10	S7126_024_0	1	1				05/25/2018	2019.01	05/25/2018 01:26:13 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	024	0	2019	Upper Midwest and Northern Plains		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	025	0		29	10	S7126_025_0	1	1				05/25/2018	2019.01	05/25/2018 01:30:31 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	025	0	2019	State of New Mexico		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	026	0		29	10	S7126_026_0	1	1				05/25/2018	2019.01	05/25/2018 01:36:39 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	026	0	2019	State of Colorado		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	027	0		29	10	S7126_027_0	1	1				05/25/2018	2019.01	05/25/2018 03:17:31 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	027	0	2019	State of Arizona		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	028	0		29	10	S7126_028_0	1	1				05/25/2018	2019.01	05/25/2018 03:20:12 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	028	0	2019	State of Nevada		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	029	0		29	10	S7126_029_0	1	1				05/25/2018	2019.01	05/25/2018 01:42:13 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	029	0	2019	States of Oregon and Washington		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	030	0		29	10	S7126_030_0	1	1				05/25/2018	2019.01	05/25/2018 01:47:23 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	030	0	2019	States of Idaho and Utah		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	031	0		29	10	S7126_031_0	1	1				05/25/2018	2019.01	05/25/2018 01:52:04 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	031	0	2019	State of California		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	032	0		29	10	S7126_032_0	1	1				05/25/2018	2019.01	05/25/2018 03:27:53 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	032	0	2019	State of Hawaii		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	033	0		29	10	S7126_033_0	1	1				05/25/2018	2019.01	05/25/2018 01:55:42 PM Eastern Daylight Time		06/04/2018 12:16:56 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	033	0	2019	State of Alaska		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	034	0		29	10	S7126_034_0	2	1				06/01/2018	2019.01	06/01/2018 04:06:49 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	034	0	2019	Northern New England		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	035	0		29	10	S7126_035_0	1	1				06/01/2018	2019.01	06/01/2018 04:07:35 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	035	0	2019	Central New England		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	036	0		29	10	S7126_036_0	1	1				06/01/2018	2019.01	06/01/2018 04:08:15 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	036	0	2019	State of New Jersey		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	037	0		29	10	S7126_037_0	1	1				06/01/2018	2019.01	06/01/2018 04:08:56 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	037	0	2019	Mid-Atlantic		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	038	0		29	10	S7126_038_0	1	1				06/01/2018	2019.01	06/01/2018 04:09:43 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	038	0	2019	States of Pennsylvania and West Virginia		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	039	0		29	10	S7126_039_0	1	1				06/01/2018	2019.01	06/01/2018 04:11:12 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	039	0	2019	State of Virginia		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	040	0		29	10	S7126_040_0	1	1				06/01/2018	2019.01	06/01/2018 04:11:56 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	040	0	2019	State of North Carolina		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	041	0		29	10	S7126_041_0	1	1				06/01/2018	2019.01	06/01/2018 04:12:49 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	041	0	2019	State of South Carolina		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	042	0		29	10	S7126_042_0	1	1				06/01/2018	2019.01	06/01/2018 04:14:38 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	042	0	2019	State of Georgia		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	043	0		29	10	S7126_043_0	1	1				06/01/2018	2019.01	06/01/2018 04:15:49 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	043	0	2019	State of Florida		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	044	0		29	10	S7126_044_0	1	1				06/01/2018	2019.01	06/01/2018 04:16:38 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	044	0	2019	States of Alabama and Tennessee		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	045	0		29	10	S7126_045_0	1	1				06/01/2018	2019.01	06/01/2018 04:17:19 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	045	0	2019	State of Michigan		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	046	0		29	10	S7126_046_0	1	1				06/01/2018	2019.01	06/01/2018 04:17:59 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	046	0	2019	State of Ohio		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	047	0		29	10	S7126_047_0	1	1				06/01/2018	2019.01	06/01/2018 04:18:41 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	047	0	2019	States of Indiana and Kentucky		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	048	0		29	10	S7126_048_0	1	1				06/01/2018	2019.01	06/01/2018 04:22:23 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	048	0	2019	State of Wisconsin		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	049	0		29	10	S7126_049_0	1	1				06/01/2018	2019.01	06/01/2018 04:23:04 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	049	0	2019	State of Illinois		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	050	0		29	10	S7126_050_0	1	1				06/01/2018	2019.01	06/01/2018 04:23:45 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	050	0	2019	State of Missouri		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	051	0		29	10	S7126_051_0	1	1				06/01/2018	2019.01	06/01/2018 04:24:25 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	051	0	2019	State of Arkansas		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	052	0		29	10	S7126_052_0	1	1				06/01/2018	2019.01	06/01/2018 04:25:04 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	052	0	2019	State of Mississippi		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	053	0		29	10	S7126_053_0	1	1				06/01/2018	2019.01	06/01/2018 04:25:43 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	053	0	2019	State of Louisiana		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	054	0		29	10	S7126_054_0	1	1				06/01/2018	2019.01	06/01/2018 04:26:20 PM Eastern Daylight Time		06/04/2018 12:17:24 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	054	0	2019	State of Texas		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	055	0		29	10	S7126_055_0	1	1				06/01/2018	2019.01	06/01/2018 04:26:59 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	055	0	2019	State of Oklahoma		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	056	0		29	10	S7126_056_0	1	1				06/01/2018	2019.01	06/01/2018 04:27:38 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	056	0	2019	State of Kansas		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	057	0		29	10	S7126_057_0	1	1				06/01/2018	2019.01	06/01/2018 04:28:21 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	057	0	2019	Upper Midwest and Northern Plains		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	058	0		29	10	S7126_058_0	1	1				06/01/2018	2019.01	06/01/2018 04:28:58 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	058	0	2019	State of New Mexico		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	059	0		29	10	S7126_059_0	1	1				06/01/2018	2019.01	06/01/2018 04:29:33 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	059	0	2019	State of Colorado		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	060	0		29	10	S7126_060_0	1	1				06/01/2018	2019.01	06/01/2018 04:30:45 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	060	0	2019	State of Arizona		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	061	0		29	10	S7126_061_0	1	1				06/01/2018	2019.01	06/01/2018 04:31:39 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	061	0	2019	State of Nevada		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	062	0		29	10	S7126_062_0	1	1				06/01/2018	2019.01	06/01/2018 04:43:15 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	062	0	2019	States of Oregon and Washington		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	063	0		29	10	S7126_063_0	1	1				06/01/2018	2019.01	06/01/2018 04:44:27 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	063	0	2019	States of Idaho and Utah		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	064	0		29	10	S7126_064_0	1	1				06/01/2018	2019.01	06/01/2018 04:45:07 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	064	0	2019	State of California		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	065	0		29	10	S7126_065_0	1	1				06/01/2018	2019.01	06/01/2018 04:45:47 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	065	0	2019	State of Hawaii		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	066	0		29	10	S7126_066_0	1	1				06/01/2018	2019.01	06/01/2018 04:46:28 PM Eastern Daylight Time		06/04/2018 12:17:25 PM Eastern Daylight Time			06/04/2018 03:07:33 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaha.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	066	0	2019	State of Alaska		2					2						www.mutualofomaha.com	www.mutualofomaha.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7694	001	0		29	10	S7694_001_0	1	1				05/31/2018	2019.01	05/31/2018 11:56:13 AM Eastern Daylight Time		05/30/2018 09:14:24 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	001	0	2019	Northern New England Region 01 - ME, NH		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	002	0		29	10	S7694_002_0	1	1				05/31/2018	2019.01	05/31/2018 11:58:38 AM Eastern Daylight Time		05/30/2018 09:15:18 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	002	0	2019	Central N England Region 02 - CT/MA/RI/VT		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	003	0		29	10	S7694_003_0	1	1				05/31/2018	2019.01	05/31/2018 12:07:33 PM Eastern Daylight Time		05/30/2018 09:15:56 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	003	0	2019	New York EnvisionRxPlus Region 03		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	004	0		29	10	S7694_004_0	2	1				05/31/2018	2019.01	05/31/2018 01:17:09 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	004	0	2019	New Jersey EnvisionRxPlus Region 04		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	005	0		29	10	S7694_005_0	1	1				05/31/2018	2019.01	05/31/2018 12:06:42 PM Eastern Daylight Time		05/30/2018 09:17:04 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	005	0	2019	Mid-Atlantic EnvisionRxPlus Region 05 - DE/DC/MD		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	006	0		29	10	S7694_006_0	1	1				05/31/2018	2019.01	05/31/2018 12:10:18 PM Eastern Daylight Time		05/30/2018 09:17:42 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	006	0	2019	Pennsylvania, WV EnvisionRxPlus Region 06		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	007	0		29	10	S7694_007_0	2	1				05/31/2018	2019.01	05/31/2018 01:28:54 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	007	0	2019	Virginia EnvisionRxPlus Region 07		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	008	0		29	10	S7694_008_0	1	1				05/31/2018	2019.01	05/31/2018 12:14:30 PM Eastern Daylight Time		05/30/2018 09:18:50 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	008	0	2019	North Carolina EnvisionRxPlus Region 08		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	009	0		29	10	S7694_009_0	1	1				05/31/2018	2019.01	05/31/2018 12:17:47 PM Eastern Daylight Time		05/30/2018 09:19:24 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	009	0	2019	South Carolina EnvisionRxPlus Region 09		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	010	0		29	10	S7694_010_0	1	1				05/31/2018	2019.01	05/31/2018 12:20:44 PM Eastern Daylight Time		05/30/2018 09:20:00 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	010	0	2019	Georgia EnvisionRxPlus Region 10		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	011	0		29	10	S7694_011_0	2	1				05/31/2018	2019.01	05/31/2018 01:32:25 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	011	0	2019	Florida EnvisionRxPlus Region 11		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	012	0		29	10	S7694_012_0	2	1				05/31/2018	2019.01	05/31/2018 01:40:37 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	012	0	2019	Alabama,Tennessee EnvisionRxPlus Region 12		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	014	0		29	10	S7694_014_0	1	1				05/31/2018	2019.01	05/31/2018 12:23:34 PM Eastern Daylight Time		05/30/2018 09:22:36 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	014	0	2019	Ohio EnvisionRxPlus Region 14		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	015	0		29	10	S7694_015_0	2	1				05/31/2018	2019.01	05/31/2018 01:44:16 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	015	0	2019	Indiana, Kentucky EnvisionRxPlus Region 15		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	016	0		29	10	S7694_016_0	2	1				05/31/2018	2019.01	05/31/2018 01:48:36 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	016	0	2019	Wisconsin EnvisionRxPlus Region 16		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	017	0		29	10	S7694_017_0	1	1				05/31/2018	2019.01	05/31/2018 01:51:34 PM Eastern Daylight Time		05/30/2018 09:24:34 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	017	0	2019	Illinois EnvisionRxPlus Region 17		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	018	0		29	10	S7694_018_0	3	1				05/31/2018	2019.01	05/31/2018 01:54:51 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/11/2018 11:45:17 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	018	0	2019	Missouri EnvisionRxPlus Region 18		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	019	0		29	10	S7694_019_0	2	1				05/31/2018	2019.01	05/31/2018 01:57:46 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	019	0	2019	Arkansas EnvisionRxPlus Region 19		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	020	0		29	10	S7694_020_0	1	1				05/31/2018	2019.01	05/31/2018 12:26:36 PM Eastern Daylight Time		05/30/2018 09:26:44 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	020	0	2019	Mississippi EnvisionRxPlus Region 20		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	021	0		29	10	S7694_021_0	2	1				05/31/2018	2019.01	05/31/2018 02:42:28 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	021	0	2019	Louisiana EnvisionRxPlus Region 21		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	022	0		29	10	S7694_022_0	2	1				05/31/2018	2019.01	05/31/2018 03:02:52 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	022	0	2019	Texas EnvisionRxPlus Region 22		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	023	0		29	10	S7694_023_0	2	1				05/31/2018	2019.01	05/31/2018 03:08:13 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	023	0	2019	Oklahoma EnvisionRxPlus Region 23		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	024	0		29	10	S7694_024_0	2	1				05/31/2018	2019.01	05/31/2018 03:10:20 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	024	0	2019	Kansas EnvisionRxPlus Region 24		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	025	0		29	10	S7694_025_0	2	1				05/31/2018	2019.01	05/31/2018 03:34:56 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	025	0	2019	Midwest/Plains EnvisionRxPlus IA/MN/MT/NE/ND/SD/WY		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	026	0		29	10	S7694_026_0	1	1				05/31/2018	2019.01	05/31/2018 03:37:13 PM Eastern Daylight Time		05/30/2018 09:30:16 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	026	0	2019	New Mexico EnvisionRxPlus Region 26		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	027	0		29	10	S7694_027_0	1	1				05/31/2018	2019.01	05/31/2018 03:52:30 PM Eastern Daylight Time		05/30/2018 09:30:54 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	027	0	2019	Colorado EnvisionRxPlus Region 27		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	028	0		29	10	S7694_028_0	1	1				05/31/2018	2019.01	05/31/2018 03:57:38 PM Eastern Daylight Time		05/30/2018 09:31:30 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	028	0	2019	Arizona EnvisionRxPlus Region 28		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	029	0		29	10	S7694_029_0	2	1				05/31/2018	2019.01	05/31/2018 04:03:21 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	029	0	2019	Nevada EnvisionRxPlus Region 29		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	030	0		29	10	S7694_030_0	1	1				05/31/2018	2019.01	05/31/2018 12:29:40 PM Eastern Daylight Time		05/30/2018 09:32:30 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	030	0	2019	Oregon, Washington EnvisionRxPlus Region 30		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	031	0		29	10	S7694_031_0	1	1				05/31/2018	2019.01	05/31/2018 04:05:50 PM Eastern Daylight Time		05/30/2018 09:33:24 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	031	0	2019	Idaho, Utah EnvisionRxPlus Region 31		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	032	0		29	10	S7694_032_0	1	1				05/31/2018	2019.01	05/31/2018 12:32:43 PM Eastern Daylight Time		05/30/2018 09:33:52 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	032	0	2019	California EnvisionRxPlus Region 32		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	033	0		29	10	S7694_033_0	2	1				05/31/2018	2019.01	05/31/2018 04:08:31 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	033	0	2019	Hawaii EnvisionRxPlus Region 33		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	034	0		29	10	S7694_034_0	1	1				05/31/2018	2019.01	05/31/2018 04:10:55 PM Eastern Daylight Time		05/30/2018 09:34:52 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	034	0	2019	Alaska EnvisionRxPlus Region 34		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	070	0		29	10	S7694_070_0	1	1				05/31/2018	2019.01	05/31/2018 12:35:49 PM Eastern Daylight Time		05/30/2018 09:40:18 PM Eastern Daylight Time			06/01/2018 09:18:50 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	070	0	2019	Michigan EnvisionRxPlus Region 13		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	105	0		29	10	S7694_105_0	2	1				05/31/2018	2019.01	05/31/2018 04:13:08 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus (PDP)	10	29					S7694	105	0	2019	Puerto Rico EnvisionRxPlus Region 38		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	106	0		29	10	S7694_106_0	2	1				05/31/2018	2019.01	05/31/2018 04:15:23 PM Eastern Daylight Time		07/10/2018 01:19:08 PM Eastern Daylight Time			07/10/2018 04:52:59 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus (PDP)	10	29					S7694	106	0	2019	Guam EnvisionRxPlus Region 36		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	801	0		29	10	S7694_801_0	1	1				05/09/2018	2019.01	05/09/2018 04:22:55 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Plan Calendar Year (PDP)	10	29					S7694	801	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	EnvisionRxPlus.com	envision.promptpa.com									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S7694	802	0		29	10	S7694_802_0	1	1				05/09/2018	2019.01	05/09/2018 04:22:58 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Group Non-Calendar Year (PDP)	10	29					S7694	802	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	EnvisionRxPlus.com	envision.promptpa.com									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S7694	803	0		29	10	S7694_803_0	1	1				05/09/2018	2019.01	05/09/2018 04:23:03 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 4TC (PDP)	10	29					S7694	803	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com/	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	804	0		29	10	S7694_804_0	1	1				05/09/2018	2019.01	05/09/2018 04:23:07 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 5TC (PDP)	10	29					S7694	804	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	805	0		29	10	S7694_805_0	1	1				05/09/2018	2019.01	05/09/2018 04:23:11 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 4TO (PDP)	10	29					S7694	805	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	806	0		29	10	S7694_806_0	1	1				05/09/2018	2019.01	05/09/2018 04:23:14 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 5TO (PDP)	10	29					S7694	806	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	807	0		29	10	S7694_807_0	1	1				05/09/2018	2019.01	05/09/2018 04:23:18 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare Bronze (PDP)	10	29					S7694	807	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	808	0		29	10	S7694_808_0	1	1				05/09/2018	2019.01	05/09/2018 04:23:30 PM Eastern Daylight Time					05/30/2018 02:53:35 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Group Broad (PDP)	10	29					S7694	808	0	2019	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	EnvisionRxPlus.com	envision.promptpa.com									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S8067	001	0		29	10	S8067_001_0	2	1				07/17/2018	2019.01	07/17/2018 12:01:12 PM Eastern Daylight Time		07/03/2018 02:05:28 PM Eastern Daylight Time			07/17/2018 12:19:01 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 3 (PDP)	10	29					S8067	001	0	2019	Region 6 - Pennsylvania, West Virginia		2					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	003	0		29	10	S8067_003_0	2	1				06/02/2018	2019.01	06/02/2018 04:34:35 PM Eastern Daylight Time		07/03/2018 02:08:38 PM Eastern Daylight Time			07/17/2018 12:19:01 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 1 (PDP)	10	29					S8067	003	0	2019	Region 06 - Pennsylvania and West Virginia		2					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	801	0		29	10	S8067_801_0	1	1				05/26/2018	2019.01	05/26/2018 05:00:19 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - ER (PDP)	10	29					S8067	801	0	2019	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	802	0		29	10	S8067_802_0	1	1				05/14/2018	2019.01	05/14/2018 12:15:57 PM Eastern Daylight Time					06/02/2018 04:46:13 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - ER - Non-Calendar PY (PDP)	10	29					S8067	802	0	2019	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8677	803	0		29	10	S8677_803_0	1	1				05/30/2018	2019.01	05/30/2018 08:04:57 AM Pacific Daylight Time					05/31/2018 02:53:02 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Part D Group Plan (PDP)	10	29					S8677	803	0	2019	National		1					2						www.providencehealthassurance.com	www.providencehealthassurance.com										(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-																
S8841	803	0		29	10	S8841_803_0	1	1				06/03/2018	2019.01	06/03/2018 11:04:10 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP 4-Tier Silver Plan - CY (PDP)	10	29					S8841	803	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	804	0		29	10	S8841_804_0	1	1				06/03/2018	2019.01	06/03/2018 11:04:22 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP 4-Tier Silver Plan - NCY (PDP)	10	29					S8841	804	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	807	0		29	10	S8841_807_0	1	1				06/03/2018	2019.01	06/03/2018 11:04:27 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP 5-Tier Bronze Plan - CY (PDP)	10	29					S8841	807	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	808	0		29	10	S8841_808_0	1	1				06/03/2018	2019.01	06/03/2018 11:04:35 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP 5-Tier Bronze Plan - NCY (PDP)	10	29					S8841	808	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	810	0		29	10	S8841_810_0	1	1				06/03/2018	2019.01	06/03/2018 11:04:53 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 MPSERS EGWP Plan (PDP)	10	29					S8841	810	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(855)577-6517		(855)577-6517		(855)577-6517		(855)577-6517										(711)-		(711)-		(711)-		(711)-																
S8841	812	0		29	10	S8841_812_0	1	1				06/03/2018	2019.01	06/03/2018 11:04:58 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP 5-Tier Gold Plan - CY (PDP)	10	29					S8841	812	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	813	0		29	10	S8841_813_0	1	1				06/03/2018	2019.01	06/03/2018 11:05:06 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP 5-Tier Gold Plan - NCY (PDP)	10	29					S8841	813	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	814	0		29	10	S8841_814_0	1	1				06/03/2018	2019.01	06/03/2018 11:05:11 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP Commercial plan - CY (PDP)	10	29					S8841	814	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	815	0		29	10	S8841_815_0	1	1				06/03/2018	2019.01	06/03/2018 11:05:19 AM Eastern Daylight Time					06/03/2018 11:07:19 AM Eastern Daylight Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	2019 EGWP Commercial plan - NCY (PDP)	10	29					S8841	815	0	2019	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S9701	801	0		29	10	S9701_801_0	1	1				05/31/2018	2019.01	05/31/2018 09:31:17 AM Central Daylight Time					05/31/2018 09:32:47 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	801	0	2019	Navitus MedicareRx		1					2						https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	802	0		29	10	S9701_802_0	1	1				05/16/2018	2019.01	05/16/2018 03:08:10 PM Central Daylight Time					05/31/2018 09:32:47 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	802	0	2019	Navitus MedicareRx		1					2						https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	803	0		29	10	S9701_803_0	1	1				05/16/2018	2019.01	05/16/2018 03:08:17 PM Central Daylight Time					05/31/2018 09:32:47 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	803	0	2019	Navitus MedicareRx		1					2						https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	804	0		29	10	S9701_804_0	1	1				05/16/2018	2019.01	05/16/2018 03:08:24 PM Central Daylight Time					05/31/2018 09:32:47 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	804	0	2019	Navitus MedicareRx		1					2						https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	807	0		29	10	S9701_807_0	1	1				05/17/2018	2019.01	05/17/2018 09:35:33 AM Central Daylight Time					05/31/2018 09:32:47 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	807	0	2019	Navitus MedicareRx		1					2						https://medicarerx.navitus.com/	https://medicarerx.navitus.com/										(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
